Examining the prevalence and characteristics of abfractionlike cervical lesions in a population of U.S. veterans.

BACKGROUND: Abfraction is believed to be caused by biomechanical loading forces. It may be due to flexure and ultimate fatigue of tooth tissues that occur away from the point of occlusal loading. Other possible causes of cervical lesions include toothbrush abrasion and erosion. The purpose of this study was to investigate the characteristics and prevalence of abfraction-like lesions in a population of U.S. veterans. METHODS: The authors evaluated 103 teeth with noncarious cervical lesions in 32 subjects and characterized them based on the surface on which the lesion was located, history of toothbrush abrasion, size of the lesion, presence of plaque, surface texture, and presence and size of occlusal wear facets. RESULTS: Clinical examination revealed that adjacent control teeth had a significantly lower percentage of surfaces with plaque than did teeth with cervical lesions. Control teeth also had significantly less gingival recession than did affected teeth. Seventy-five percent of subjects reported a history of using a firm toothbrush, and 78.1 percent reported using a brushing technique that is known to cause toothbrush abrasion in the affected area. Affected teeth had neither significantly different occlusal wear facets nor occlusal contacts than control teeth. No significant correlations were found between cervical lesion dimensions and facet area. CONCLUSIONS: Toothbrush abrasion is strongly suspected as contributing to the formation of the majority of wedge-shaped lesions in this group of subjects. A small subset of lesions is thought to have resulted from some other phenomenon. Although the presence or contribution of occlusal stresses in the direct formation of these lesions could not be measured directly, the possibility of abfraction could not be eliminated. CLINICAL IMPLICATIONS: Because the existence of abfraction could not be ruled out in about 15 percent of the cases, teeth with noncarious, wedge-shaped lesions warrant careful occlusal evaluation, with the possible need for occlusal adjustment or bitesplint therapy to treat bruxism.

Titanium endosseous implant-soft tissue interface: a literature review.

Background information about normal periodontal anatomy and titanium used in endosseous implant fabrication is provided. Literature is reviewed concerning epithelial and connective tissue attachment to titanium. Information about the adequacy of cell attachment to implants, possible mechanisms of cell attachment formation, and the effect of implant surface properties on attachment is presented. A chemical attachment between titanium implant surface oxide layer and epithelium has been demonstrated in vitro and in vivo. This attachment is mediated by a glycoprotein similar to that seen between epithelium and natural tooth surfaces. While only minimal histological evidence exists, connective tissue fibers adjacent to titanium implanted surfaces may bring the tissue in tight apposition to the implant without an absolute biologic attachment between the implant and connective tissue. Alteration of the titanium surface morphology may selectively enhance the attachment of either epithelial cells or fibroblasts, theoretically enhancing the formation of a biologic seal between the implanted titanium surface and its adjacent tissue. A greater understanding of the mechanisms of attachment and of the factors which enhance the integrity of the biologic seal between implant and soft tissues should permit an improved prognosis for functioning titanium implants.

Sodium absorption associated with oral hygiene procedures.

A two-phase study was conducted to determine if sodium is absorbed in significant amounts by the oral mucosa during use of saline solutions. If such absorption occurs, saline rinsing procedures should be contraindicated for people on sodium-restricted diets.

Periodontics. Diagnostic, prognostic and treatment planning considerations.

The periodontal disease syndromes present the practitioner with an extensive array of clinical conditions. However, by performing a careful examination and recording of findings, the clinician will provide order to this seemingly complex picture. This careful and reasoned approach is based on a logical sequence starting with clinical observations that lead to a diagnosis of the disease entity present. This correct diagnosis in turn will lead to establishment of the prognosis and the therapeutic approach. By following these precepts, the practitioner ensures a sound biologic basis for his or her efforts. The end result is the realization of the goal of dental therapy that her is for the patient to maintain dentition in health, comfort, and function for a lifetime and minimize the potential for urgent periodontal needs.

Effect of a local germicide on the occurrence of bacteremia during subgingival scaling.

The purpose of this investigation was to determine the effectiveness of irrigating periodontal pockets with povidone-iodine in reducing the incidence of bacteremia found during subgingival scaling. Twenty male patients requiring subgingival scaling had the following factors recorded on two contralateral groups of three posterior teeth: age, race, mean pocket depth, mobility, and scores of gingival, plaque, calculus, bleeding indices. In control areas, 5 ml blood samples were taken before, during and after scaling through an in dwelling Minicath. In experimental areas, the patients first rinsed with a povidone-iodine mouthwash for 1 minute, and the teeth then received a 3-minute sulcus irrigation with 10% povidone-iodine. Blood samples were taken as with the controls, and also 2 minutes after the irrigation. Blood samples were anaerobically cultured, and isolates were classified by Gram staining and cellular morphology. No significant difference in factors between control and experimental areas was noted. All preoperative blood cultures, including those taken 2 minutes after irrigation, were negative. In the 11 patients (55%0 who showed positive cultures during the scaling, cultures were positive in both control and experimental areas. None of the preoperatively recorded factors in either control or experimental ares were significantly correlated with the occurrence of bacteremia. Local degerming by mouthrinsing and sulcus irrigation with povidone-iodine prior to subgingival scaling seems neither to increase nor decrease the incidence of bacteremia.

Ill effects of improper oral hygeine procedure.

Improper use of the tools that prevent tooth decay and gingival disease can also produce harmful effects. For example, dental floss can cause inflammation; toothbrushes could cause abscesses; and water-irrigation devices might drive foreign material into soft tissue. This report discusses the effects of incorrect oral hygiene, the signs the practioner should notice, and the proper corrective steps. Although effective oral hygiene is essential for the maintenance of healthy teeth and supporting tissues, analysis of the literature and clinical observation suggested that six problem areas may be associated with common oral hygiene measures. --Overly vigorous toothbrushing or using the wrong type of brush for the technique often leads to cervical tooth abrasion, gingival irritation, and gingival recession, or all of these problems. --Uncontrolled or overly vigorous dental flossing may lead to irritation, ulceration, or defects of the gingiva. Proximal root surfaces are rarely abraded. --Dentifrices, mouthwashes, and chewing gum may elicit allergic or toxic reactions in susceptible persons. These reactions take a variety of traumatic injuries, especially if used at high pressure. Perhaps, detailed individual instruction should be given by dental personnel before use. --Abscess of gingival tissues may occur from implantation of fragments of such oral hygiene aids as toothbrush bristles and toothpicks. --Bacteria may enter the bloodstream during certain oral hygiene measures, especially in patients with advanced chronic gingival disease. The rate of occurrence is unknown because of conflicting results in different studies. These bacteremias are of concern to patients who have rheumatic heart disease, prosthetic heart valves, prosthetic joints, and renal dialysis shunts, or fistulas used in renal dialysis. A classification of oral hygiene-caused disorders is proposed, based on the injury and the causative agent.

Effect of postmortem tissue fixation on tooth mobility and pocket depth in human beings.

With the exception of dry skulls, postmortem human material is rarely used in the study of periodontal disease. If the relationship between clinical periodontal measurements, such as mobility and pocket depth, were known antemortem versus postmortem, a new source of information would be available. In this study, such measurements were performed on a patient whose mandible was resected because of a malignant condition. Mobility was found to have decreased; pocket depths initially increased, and then returned to nearly preoperative levels.