An indirect technique for assuring simplicity and marginal integrity of provisional restorations during full mouth rehabilitation.

Full mouth rehabilitation with fixed prosthodontics can be a time- and labor-intensive process. The use of provisional restorations allows the treating clinician to determine the functional and esthetic requirements of the definitive prostheses. However, in the case of full mouth rehabilitation, the individual preparation of provisional restorations for multiple teeth may complicate the provisional phase and increase the treatment time. This article describes a method to simplify the indirect fabrication of provisional restorations for full mouth reconstruction. Provisional restorations may be easily achieved by splinting the provisional restorations in sextants, trimming them according to red pencil marks around the prepared margins as guidelines, and fitting them in the laboratory, utilizing a second set of solid casts for the prepared teeth.

Biotribological behavior of two retrieved implant abutment screws after long-term use in vivo.

PURPOSE: To evaluate the effect of functional cyclic loading on two retrieved abutment screws used with single implant supporting cement-retained porcelain-fused-to-metal crowns by characterizing the structure, properties, and biotribologic behavior after long-term use in vivo. MATERIALS AND METHODS: Two abutment screws were retrieved from the same patient and same implant at two different times. An external hex implant was used to replace a missing central incisor. A traumatic incident occurred 9 months after insertion and displaced the implant palatally by bending the screw. A second, similar incident occurred 31 months after insertion. In both cases, the abutment screws were retrieved and subjected to thorough nondestructive and destructive testing. RESULTS: Light and scanning electron microscopic examinations revealed very minimal surface deterioration of the thread profile for the first screw (in service for 9 months) and demonstrated advanced metal adhesive wear in the form of galling for the second screw (in service for 31 months). The galling led to moderate thinning of the thread profile. Both screws were composed of Au-based alloy, where the microstructure of the matrix consisted of homogeneous equiaxed fine grains with two different second phase particles. CONCLUSION: It appears that the occurrence of adhesive wear on abutment screws in the form of galling is highly related to the length of in-service time in the mouth. This biotribologic behavior was inevitable and considered to be a normal consequence of long-term use in vivo. Metallurgic analysis indicated that both screws were identical in terms of composition and microstructure.

Inclusion of oral-systemic health in predoctoral/undergraduate curricula of pharmacy, nursing, and medical schools around the world: a preliminary study.

There is increasing evidence that oral health is a critical component of overall health and that poor oral health may lead to initiation or exacerbation of chronic inflammatory diseases/conditions and adverse pregnancy outcomes. Added to this is an increasing awareness that among non-dental health care professions curricula (e.g., medicine, nursing, pharmacy, and allied health) there is an apparent lack of information regarding the interrelationships between oral health and overall health or recognition of the significance of oral health in achieving and sustaining general health outcomes. This study explored the amount of information related to oral-systemic science currently being taught in the predoctoral/undergraduate professional curricula of pharmacy, nursing, and medical schools in English-speaking universities around the world. The Oral-Systemic Health Educational Curriculum Survey was circulated online to associate or academic deans at medical, nursing, and pharmacy schools in universities across Canada, the United States, Europe, Asia, Australia, and New Zealand. The survey found that 53.7 percent of the respondents ranked the inclusion of oral-systemic science as somewhat important, 51.2 percent reported no or limited requirements to incorporate oral health education within their curricula, and 59.6 percent rated their current curricula in oral-systemic health as inadequate. The majority of students in these programs are not being instructed to examine the mouth, nor are they being taught how to perform an oral examination. Despite growing awareness of emerging evidence of oral-systemic relationships and recommendations that all health care providers should contribute to enhancing oral health, this knowledge base appears to be substantially deficient in the curricula of pharmacy, nursing, and medical students in many universities. This study provides the first formal documentation that the curricula of non-dental health care professions, specifically in medicine, nursing, and pharmacy, do not contain adequate content related to oral-systemic health.

Prognosis in implant dentistry: a system for classifying the degree of peri-implant mucosal inflammation.

Disease related to peri-implant mucosal inflammation (PIMI) has been reported as one of the major factors leading to failure of dental implants. Many authors have suggested options for treatment of these lesions, ranging from simple mechanical debridement and regenerative surgical techniques to removal of the implant. Prognostic classification systems have become an integral part of dental practice because they provide direct guidance in planning treatment. However, there is limited evidence to support the appropriate classification of PIMI and the corresponding treatments, and a more specific prognostic system is required. Because the number of patients with implants is increasing, clinicians must be aware of PIMI as an entity with specific management requirements. This report describes a simple prognostic system to help clinicians to foresee the outcomes of PIMI treatment.

An update on novel non-invasive approaches for periodontal diagnosis.

For decades there has been an ongoing search for clinically acceptable methods for the accurate, non-invasive diagnosis and prognosis of periodontitis. There are several well-known inherent drawbacks with current clinical procedures. The purpose of this review is to summarize some of the newly emerging diagnostic approaches, namely, infrared spectroscopy, optical coherence tomography (OCT), and ultrasound. The history and attractive features of these new approaches are briefly illustrated, and the interesting and significant inventions related to dental applications are discussed. The particularly attractive aspects for the dental community are that some of these methods are totally non-invasive, do not impose any discomforts to the patients during the procedure, and require no tissue to be extracted. For instance, multiple inflammatory indices withdrawn from near infrared spectra have the potential to identify early signs of inflammation leading to tissue breakdown. Morphologically, some other non-invasive imaging modalities, such as OCT and ultrasound, could be employed to accurately measure probing depths and assess the status of periodontal attachment, the front-line of disease progression. Given that these methods reflect a completely different assessment of periodontal inflammation, if clinically validated, these methods could either replace traditional clinical examinations for the diagnosis of periodontitis or at least serve as attractive complementary diagnostic tools. However, the potential of these techniques should be interpreted more cautiously given the multifactorial character of periodontal disease. In addition to these novel tools in the field of periodontal inflammatory diseases, other alternative modalities like microbiologic and genetic approaches are only briefly mentioned in this review because they have been thoroughly discussed in other comprehensive reviews.

Factors associated with receipt of preventive dental treatment procedures among adult patients at a dental training school in Wisconsin, 2001-2002.

BACKGROUND: Gender differences in oral health-related quality of life and the fear of dental pain in seeking and receiving preventive dental care have been recognized and documented. Preventive dental treatment procedures (PDTPs) are commonly accepted as the primary approach to prevent dental disease. OBJECTIVE: We examined whether the likelihood of receiving PDTPs differed by gender in adult patients receiving dental care at a dental training institution in Milwaukee, Wisconsin. METHODS: Data from the Marquette University School of Dentistry electronic patient management database for 2001 through 2002 were analyzed. Descriptive, bivariate, and multivariable analyses were performed. The preventive procedures used in the study were those coded in accordance with the American Dental Association's classification system: D1110 (adult prophylaxis: professional cleaning and polishing of the teeth), D1204 (adult topical application of fluoride), D1205 (adult topical application of fluoride plus prophylaxis), and D1330 (oral hygiene instruction). RESULTS: Of the 1563 consecutive patient records (888 women, 675 men) reviewed for the years 2001-2002, 794 individuals (51%), aged 18 to 60 years, were identified as having received PDTPs. At the bivariate level, a significant gender difference in the receipt of PDTPs was identified (423 women [48%] vs 371 men [55%]; P = 0.004). In the multivariable analyses, age, race/ethnicity, marital status, poverty level, and health insurance type (public, private, none) were significantly associated with the receipt of PDTPs (all, P < 0.05), but gender was not. CONCLUSIONS: Gender differences in receiving PDTPs were not found in this dental school patient population. Receipt of PDTPs was associated with other demographic factors such as age, race/ethnicity, marital status, income level, and health insurance.

Periodontal-systemic disease education in U.S. and Canadian dental schools.

Research has proliferated in recent years regarding the relationship of oral disease to systemic conditions. Specifically, periodontal disease has been studied as a potential risk factor for multiple conditions such as cardiovascular disease (CVD) and adverse pregnancy outcomes, while other research focuses on exposures or behaviors associated with oral disease. However, few articles have been published reporting how this information is integrated into schools of dentistry, both in the classroom and clinical curriculum. For our study, a thirty-three-item survey and cover letter were electronically mailed to academic deans at sixty-five accredited dental schools in the United States and Canada in the fall of 2007. The response rate was 77 percent. According to the responses to this survey, the primary topics covered in the didactic curriculum regarding periodontal oral-systemic disease are aging, CVD, diabetes, and tobacco use. Eighty-eight percent of the respondents reported that their students are knowledgeable about the role of inflammation and its impact on oral-systemic conditions. Forty-eight percent of the respondents said they provide formal training for their students in how to discuss or communicate aspects of periodontal oral-systemic disease with patients. Only seven schools reported teaching didactic content to dental students intermixed with other health professions students, and only two schools reported conducting joint projects. Only 9 percent of the respondents said they think nurses and physicians are knowledgeable about oral-systemic disease. The findings indicate that dental schools are confident about the knowledge of their students regarding oral-systemic content. However, much work is needed to educate dental students to work in a collaborative fashion with other health care providers to co-manage patients at risk for oral-systemic conditions.

Socio-demographics of adult orthodontic visits in the United States.

INTRODUCTION: Population-based studies in orthodontics have focused on differences between normative and perceived needs. However, information from national data on the prevalence of orthodontic visits and their associated factors in adults in the United States is scarce. We examined the demographic profile of likely adult users of orthodontic services and whether there is racial and ethnic disparity in orthodontic visits. METHODS: We analyzed data from the Medical Expenditure Panel Survey, 2000-2004. RESULTS: Overall, about 1% of the population reported an orthodontic visit. Subjects who made a general dental visit during the current year were significantly more likely to also have an orthodontic visit. Single adults, women, people between 18 and 30 years of age, and those from high-income families were more likely to report an orthodontic visit. There were no indications of racial and ethnic disparity for either black or Hispanic adults compared with white adults after adjusting for other covariates. CONCLUSIONS: Substantial racial and ethnic disparity in adult orthodontic usage was not identified. Adults (ages 18-30 years), women, those with higher incomes, and single adults had significantly higher odds of reporting an orthodontic visit. However, additional studies specifically evaluating the association of treatment need among low-income families are required to evaluate whether these adults face significant barriers in accessing orthodontic care.

Racial/ethnic disparities in the acceptance of Medicaid patients in dental practices.

OBJECTIVES: Medicaid enrollees disproportionately experience dental disease and difficulties accessing needed dental care. However, little has been documented on the factors associated with the acceptance of new Medicaid patients by dentists, and particularly whether minority dentists are more likely to accept new Medicaid patients. We therefore examined the factors associated with the acceptance of new Medicaid patients by dentists. METHODS: We analyzed 2001 data from the Wisconsin Dentist Workforce Survey administered by the Wisconsin Division of Health Care Financing, Bureau of Health Information. We used descriptive statistics and logistic regression analysis to examine the factors associated with the outcome variable. RESULTS: Ninety-four percent of Wisconsin licensed dentists (n = 4,301) responded to the 2001 survey. A significantly higher likelihood of accepting new Medicaid patients was found for racial/ethnic minority dentists (35 versus 19 percent of White dentists) and dentists practicing in large practices (31 versus 16 percent for those in smaller practices). In the multivariable analysis, minority dentists [odds ratio (OR) = 2.06, 95 percent confidence interval (CI) = 1.30, 3.25] and dentists in practices with >3 dentists (OR= 2.25, 95 percent CI = 1.69, 3.00) had significantly greater odds of accepting new Medicaid patients. CONCLUSIONS: Racial/ethnic minority dentists are twice as likely as White dentists to accept new Medicaid patients. Dentists in larger practices also are significantly more likely than those in smaller practices to accept new Medicaid patients. These findings suggest that increasing dental workforce diversity to match the diversity of the general US population can potentially improve access to dental care for poor and minority Americans, and may serve as an important force in reducing disparities in dental care.