Oral Hygiene Habits of Complete Denture Wearers in Central Transylvania, Romania.

PURPOSE: To identify the oral hygiene habits and denture hygiene status (e.g. sociodemographic characteristics, general health status) of complete denture wearers in Central Transylvania, Romania. MATERIALS AND METHODS: This descriptive cross-sectional study was based on an original self-administered questionnaire. It included 162 patients who experienced complete tooth loss in one or both jaws and wore polymethylmethacrylate acrylic (PMMA) complete dentures. The exclusion criteria were partial dentures, dentures fabricated from materials other than PMMA, and the patient being unable to provide all the required information. The questionnaire solicited information regarding sociodemographic status, general health and oral hygiene-related habits. The dentures were clinically evaluated in order to assess denture hygiene. RESULTS: Most respondents were completely edentulous (38.0% wore maxillary dentures, 10.6% mandibular dentures, while 51.6% had both), with an average age above 60, all wearing dentures. The clinical evaluation of the dentures revealed that 12.3% exhibited optimal hygiene status, 40.1% good, 32.7% unsatisfactory and 14.8% bad, with more women than men having well-cleaned dentures. Cleaning frequency was found to be 2-3 times per day for 54.3% of the patients, with 93.2% of the subjects using a toothbrush and 76.5% using toothpaste. Most of the participants felt at ease with the cleaning procedures. Only 30.9% of the respondents reported denture removal overnight. The results showed that the hygiene of the patients' dentures was not correlated with their answers regarding oral hygiene habits. CONCLUSIONS: Competent oral health and denture hygiene promotion should be established, especially regarding nocturnal denture removal, denture hygiene methods, instruments and cleaning frequency.

Is PostureScreen® Mobile app an accurate tool for dentists to evaluate the correlation between malocclusion and posture?

OBJECTIVE: To determine whether PostureScreen® Mobile app is a useful, simple tool that is accessible for dentists to evaluate the correlation between malocclusion and posture. METHODS: Twenty-nine subjects underwent static and dynamic dental occlusion examinations and a postural exam with PostureScreen® Mobile app, a photographic method. The subjects were divided into groups depending on their static and dynamic occlusion features. The postural parameters were then compared between these groups. RESULTS: Statistically significant differences (p < 0.05) for some postural parameters were obtained for Angle Class 1 vs. 2 and 3 and for the passive interference group and active premature contacts group during left lateral movement. There were no statistically significant differences regarding protrusion and right lateral movement. DISCUSSION: Dental occlusion anomalies and posture pathological modifications can be inter-related. PostureScreen® Mobile app might represent a useful tool in the early diagnosis of dental occlusion pathology.

Flexural strength, biocompatibility, and antimicrobial activity of a polymethyl methacrylate denture resin enhanced with graphene and silver nanoparticles.

OBJECTIVE: The study evaluates the effect of adding graphene-Ag nanoparticles (G-AgNp) to a PMMA auto-polymerizing resin, with focus on antibacterial activity, cytotoxicity, monomer release, and mechanical properties. MATERIALS AND METHODS: Auto-polymerizing acrylic resin (M) was loaded with 1 wt% G-AgNp (P1) and 2 wt% G-AgNp (P2). Methyl methacrylate monomer release (MMA) was measured after immersion of the samples in chloroform and cell medium respectively. Cell viability was assessed on dysplastic oral keratinocytes (DOK) and dental pulp stem cells. Oxidative stress and inflammatory response following exposure of dysplastic oral keratinocytes to the experimental resins was evaluated. Antibacterial activity against Staphylococcus aureus, Streptococcus mutans and Escherichia coli and also flexural strength of the resins were assessed. RESULTS: Residual monomer: For samples immersed in chloroform, MMA concentration reached high levels, 10.27 µg/g for sample P1; MMA increased at higher G-AgNp loading; 0.63 µg/g MMA was found in medium for P1, and less for sample P2. Cell viability: Both cell lines displayed a viability decrease, but remained above 75%, compared to controls, when exposed to undiluted samples. Inflammation: proinflammatory molecule TNF-α decreased when DOK cultures were exposed to G-AgNp samples. MDA levels indicated increased oxidative stress damage in cells treated with PMMA, confirmed by the antioxidant mechanism activation, while samples containing G-AgNp induced an antioxidant effect. All tested samples showed antibacterial properties against Gram-positive bacteria. Samples containing G-AgNp also exhibited bactericide action on E. coli. Mechanical properties: both samples containing G-AgNp improved flexural strength compared to the sample resin, measured through elastic strength parameters. CONCLUSIONS: PMMA resin loaded with G-AgNp presents promising antibacterial activity associated with minimal toxicity to human cells, in vitro, as well as improved flexural properties. CLINICAL RELEVANCE: These encouraging results obtained in vitro support further in vivo investigation, to thoroughly check whether the PMMA loaded with graphene-silver nanoparticles constitute an improvement over current denture materials.

Dentists' perspectives on the reconstruction possibilities of a non-vital tooth.

BACKGROUND AND AIMS: The decision-making process when restoring a non-vital tooth is influenced by multiple factors. This study aimed to survey the dentists' preferences regarding cast post-and-core and fiber post techniques for the reconstruction of non-vital teeth and to identify a correlation between reconstruction technique and practitioners characteristics, or dental characteristics. METHODS: The survey instrument was a questionnaire, which included a general part with questions regarding the practitioner's profile (gender, age, years of experience, pattern and location of practice, etc.) and the dental characteristics (anterior or posterior position of the tooth on the arch, the amount of dental remaining tissues, etc.) and a technical part, containing more specific questions regarding the manufacture and performance of root-coronal reconstructions. RESULTS: Among the surveyed practitioners (n=35), 69.7% use more often cast post-and-core reconstructions (CPR) while 30.3% choose fiber post reconstructions (FPR). No difference in the reconstruction type was observed regarding patient's age (p=0.23) or gender (p=0.092). The para-function criterion was considered important by 8.23% of the participants. When deciding the type of the root-coronal reconstruction depending on the remaining dentine walls, CPRs are significantly more frequently used in posterior areas (p=0.043) or when para-functional habits exist (p=0.022). CONCLUSION: Cast post-and-core represent the most frequently used type of reconstruction for non-vital teeth. Fiber post reconstructions are indicated in the aesthetic zone and when the amount of healthy remaining dental structure is higher.

Effects of non-surgical periodontal therapy on periodontal laboratory and clinical data as well as on disease activity in patients with rheumatoid arthritis.

OBJECTIVES: To compare the effect of non-surgical periodontal therapy on clinical and inflammatory parameters in patients with moderate to severe chronic periodontitis (CP) and rheumatoid arthritis (RA) (RA-CP) with that in CP patients without RA. MATERIAL AND METHODS: Eighteen patients with RA-CP and 18 systemically healthy patients with CP were treated with scaling and root planing (SRP) within 24 h. At baseline, and at 3 and 6 months after SRP, clinical periodontal parameters, inflammatory markers, and microorganisms in subgingival biofilm were assessed. In addition, disease activity markers of RA (DAS28, CRP, ESR) and specific antibodies (RF) were monitored in the RA-CP group. RESULTS: In both groups, non-surgical therapy yielded to statistically significant improvements in all investigated clinical periodontal variables; in RA patients, a statistically significant decrease in serum-CRP was seen at 3 months. At all time-points, levels of inflammatory markers in GCF were higher in RA-CP than in CP patients. Counts of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola decreased statistically significantly in CP but not in the RA-CP group. Changes of DAS28 correlated positively with those of P. gingivalis and negatively with the plaque index. CONCLUSIONS: Within their limits, the present data suggest that (a) non-surgical periodontal therapy improves periodontal conditions in CP patients with and without RA and (b) in patients with RA, eradication of P. gingivalis in conjunction with a high level oral hygiene may transiently decrease disease activity of RA. CLINICAL RELEVANCE: In patients with RA and CP, non-surgical periodontal therapy is a relevant modality not only to improve the periodontal condition but also to decrease RA activity.

Association of Oral-Health Related Quality of Life and General Health Assessment in Patients with Rheumatoid Arthritis.

PURPOSE: To determine the impact of oral health related quality of life (OHRQoL) on general health in patients suffering from rheumatoid arthritis (RA). MATERIALS AND METHODS: Ninety-one patients with RA (mean age 52.82 ± 11 years, 75.82% female, 20.87% smokers) and 30 systemically healthy patients (control) were evaluated for their OHRQoL by means of the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile (OHIP)-14 questionnaires. Self-perceived RA status was assessed using the Routine Assessment of Patient Index Data 3 (RAPID3). RESULTS: The mean SC-GOHAI score was 3.69 ± 2.47 for RA subjects and 1.36 ± 2.69 in the control group. Statistically significant differences were seen between RA and control groups (p < 0.05). RA patients with and without periodontitis (PA) exhibited similar SC-GOHAI (Simple Count GOHAI) scores (p = 0.980). No statistically significant differences were observed between any of the groups, either for the OHIP 14-extent or for the OHIP 14-prevalence. RAPID3 scores showed that the majority of the RA patients (65.93%) had high disease severity (RAPID3 >12, mean RAPID3 score 14.39 ± 5.14). Statistically significantly higher values were recorded for general health assessment (PTGE, p = 0.009) and fatigue (FT, p = 0.004) in RA with PA as compared to those without. SC-GOHAI with values between 5 and 8 was statistically significantly associated with high severity health impairment (RAPID3 >12, p = 0.014, OR: 8.64). CONCLUSION: Within their limits, the present findings indicate that: a) moderate OHRQoL as assessed by GOHAI may contribute to high severity impairment of health in RA patients, and b) the GOHAI questionnaire may represent a more adequate tool than OHIP-14 for assessing OHRQoL in patients suffering from RA.

Dentists' perspectives on the choice of treatment of teeth with apical periodontitis.

BACKGROUND AND AIM: Therapeutic decision in dentistry is a complex cognitive process for the practitioners because it involves taking into consideration several factors, including patients' preferences. The hypothesis of this study was that apicoectomy might be indicated more often than necessary and in order to confirm or invalidate it a survey was designed. We also aimed to explore whether the preferences were associated or not with dentist-related or practice-related characteristics. METHODS: The survey included questions about treatment options in case of four scenarios, each one concerning an anterior and a posterior tooth with apical periodontitis, with or without previous endodontic treatment and also general questions, such as medical specialties, age and years of experience. The distribution of the questionnaires was done by email and direct distribution in the dental offices, in Cluj County, Romania. RESULTS: After descriptive statistical analysis was performed, preferences rates were subjected to Chi-square test (including McNemar test for significance). Statistically significant differences were considered when p≤0.05. CONCLUSIONS: The results indicate that dentists prefer nonsurgical endodontic treatment in case of a tooth with apical periodontitis. Apicoectomy was the second option treatment preferred by general dentists, oral and maxillo-facial surgeons, prosthodontists and endodontists.

One year results of a randomized controlled clinical study evaluating the effects of non-surgical periodontal therapy of chronic periodontitis in conjunction with three or seven days systemic administration of amoxicillin/metronidazole.

BACKGROUND: To evaluate the clinical outcomes 12 months after systemic administration of amoxicillin (AMX) and metronidazole (MET) adjunctive to subgingival debridement (SD) in patients with severe chronic periodontitis (sChP). MATERIAL AND METHODS: 102 patients with sChP were treated randomly as follows: SD within 2 consecutive days and placebo for 7 days (group A), SD+AMX+MET (both 500mg x3 times daily TID) for 3 days (group B), SD+AMX+MET (both 500mg x 3 TID) for 7 days (group C). At baseline, at 3-, 6-, and 12-months post-treatment probing pocket depth (PD), clinical attachment level (CAL), furcation involvement, bleeding on probing (BOP), full-mouth plaque score (FMPS) were determined. The reduction in the number of sites with PD≥6mm was defined as main outcome variable. RESULTS: 75 patients completed the study. At 12 months, all three treatment groups showed statistically significant improvements (p<0.001) of mean PD, CAL, BOP and number of sites with PD≥6mm compared to baseline. Mean residual PD were statistically significantly lower and CAL gain statistically significantly greater in the two antibiotic groups as compared to placebo. While PD reductions (p = 0.012) and CAL gain (p = 0.017) were statistically significantly higher in group C compared to group A, only the 3-day AB group showed statistically significantly fewer sites with PD≥6mm at 12 m (p = 0.003). The reduction in the number of sites with PD≥6 mm (primary outcome) showed no statistical significant differences between the 3 treatment groups. However, in both antibiotic groups significantly more patients compared to the placebo group reached a low risk for disease progression at 12 months (≤4 sites with PD≥5mm). CONCLUSION: At 12 months, both adjunctive antibiotic protocols resulted in statistically significantly greater clinical improvements compared to placebo.

Clinical evaluation of a porcine acellular dermal matrix for the treatment of multiple adjacent class I, II, and III gingival recessions using the modified coronally advanced tunnel technique.

OBJECTIVE: To evaluate the clinical efficacy of a new porcine acellular dermal matrix (PADM) for the treatment of Miller Class I, II, and III multiple gingival recessions using the modified coronally advanced tunnel technique (MCAT). METHOD AND MATERIALS: Twelve nonsmoking, systemically healthy patients presenting at least two adjacent Miller Class I, II, or III gingival recessions (GR), with a minimal depth of 2 mm, were treated consecutively with MCAT in conjunction with PADM. At baseline and 12 months postoperatively, complete root coverage (CRC, eg 100% root coverage), mean root coverage (RC), recession depth, recession width, attached gingiva (AG), keratinized tissue (KT), periodontal pocket depths (PD), and clinical attachment level (CAL) were evaluated. The main outcome variable was CRC. RESULTS: Postoperative healing was uneventful in all cases, without any matrix loss or exposure or infection. Statistically significant improvements (P < .0001) were observed 12 months postoperatively in 53 of the included 54 GR (98.15%). Twenty two recessions (40.74%) showed CRC while the mean RC measured 73.20 ±â€¯27.71%. Mean GR reduction was 2.06 ±â€¯1.18 mm while the gain of AG amounted to 0.84 ±â€¯0.73 mm and of KT to 0.69 ±â€¯0.51 mm, respectively. There were no statistically significant changes for PD at 12 months; CAL showed a significant decrease (P < .05) at 12 months from 3.77 ±â€¯1.28 mm to 2.30 ±â€¯1.02 mm. CONCLUSION: PADM in conjunction with MCAT may be successfully utilized for the treatment of Miller Class I, II, and III multiple adjacent GR.

Etiological factors associated with temporomandibular joint disorder - study on animal model.

The etiology of temporomandibular disorder (TMD) is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. The main objectives of our study were investigation and analysis of the degree of involvement for several presumptive etiological factors of TMD: biomechanical stress (BS), estrogen hormones (EH) and emotional stress (ES). Six groups (n=10) of mature female Wistar rats were included in the study. Single presumptive etiological factor was applied in three groups (BS, EH and ES groups) and also association of presumptive etiological factors were applied in two groups (BSEH and BSES groups). No etiological factor was applied for the control group. Animals were sacrificed after a 60 days period and histological analysis of the temporomandibular joint (TMJ) tissues was performed. The changes in the mandibular cartilage, articular disc, temporal bone and synovial tissue were observed under optical magnification and quantified. All samples developed changes in the thickness of the condylar cartilage comparing to control group. The reduction was highly statistical significant for the EH, ES and BSES groups (p<0.001) and statistical significant for the BS and BSEH groups (p<0.05). The most important modifications with severe cartilage thickness reduction have been obtained in case of BSES group. In conclusion, biomechanical, emotional stress and estrogens can be considered as possible etiological factors in TMD.

Non-surgical periodontal treatment in conjunction with 3 or 7 days systemic administration of amoxicillin and metronidazole in severe chronic periodontitis patients. A placebo-controlled randomized clinical study.

AIM: To evaluate the effect of 3 or 7 days systemic administration of amoxicillin (AMX) and metronidazole (MET) or placebo as adjunct to non-surgical periodontal treatment in severe chronic periodontitis patients. METHODS: One hundred and two patients with severe chronic periodontitis [e.g. ≥1 site with probing pocket depth (PD) ≥ 6 mm per quadrant] were randomly divided into three equally sized groups and treated with either scaling and root planing within 24 h (SRP) + placebo (Group A) or SRP + AMX + MET (both 500 mg × 3 times daily) for 3 days (Group B) or SRP + AMX + MET (both 500 mg × 3 times daily) for 7 days (Group C). PD, clinical attachment level (CAL), bleeding on probing (BOP), full-mouth plaque scores (FMPS) and gingival bleeding index (GBI) were assessed prior to treatment (baseline), and at 3 and 6 months post-treatment. The primary outcome variable was the difference (Δ) in the number of sites with PD ≥ 6 mm. RESULTS: Ninety-one patients completed the study. At both 3 and 6 months, all three treatment protocols resulted in statistically significant improvements compared to baseline for all evaluated clinical parameters (p < 0.001). At 6 months, a statistically significantly greater reduction in the mean number of sites with PD ≥ 6 mm was observed in group B (28.62 ± 15.32 sites) and group C (30.45 ± 15.04 sites) compared to the placebo group (17.10 ± 14.68 sites). Furthermore, both the 3- and the 7-day antibiotic regimen resulted in statistically significantly higher clinical improvements compared to the placebo group (p < 0.05). CONCLUSION: The present findings indicate that in patients with severe chronic periodontitis, non-surgical periodontal therapy in conjunction with a 3 or 7 days systemic administration of AMX + MET may lead to significantly greater clinical improvements compared to non-surgical therapy alone.

Factors involved in the etiology of temporomandibular disorders - a literature review.

BACKGROUND AND AIM: This review aims at presenting a current view on the most frequent factors involved in the mechanisms causing temporomandibular disorders (TMD). METHOD: We conducted a critical review of the literature for the period January 2000 to December 2014 to identify factors related to TMD development and persistence. RESULTS: The etiology of TMD is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. Occlusal overloading and parafunctions (bruxism) are frequently involved as biomechanical factors; increased levels of estrogen hormones are considered biological factors affecting the temporo-mandibular-joint. Among bio-psychosocial factors, stress, anxiety or depression, were frequently encountered. CONCLUSIONS: The etiopathogenesis of this condition is poorly understood, therefore TMDs are difficult to diagnose and manage. Early and correct identification of the possible etiologic factors will enable the appropriate treatment scheme application in order to reduce or eliminate TMDs debilitating signs and symptoms.

The Influence of Root-End Filling Materials on Bone Healing - An Experimental Study.

AIMS: The aim of this experimental study is to assess the bone healing phenomenon produced in the presence of several dental materials: a polycarboxylate cement, a glass-ionomer cement, a composite resin and MTA (mineral trioxide aggregate) based cement. METHODS: The biocompatibility of four root-end fillings materials, used in periapical surgery was investigated after intra-osseous implantation of the materials in rats' calvaria. Tissue reaction was studied at 2, 4, 6, 8, 10 and 12 weeks after implantation. We took into consideration the presence of inflammatory cells (polymorphonuclear leukocytes, macrophages, plasma cells, lymphocytes and giant cells) and classified the aspects of the histological samples according to the following scale: 0 - no inflammation, 1 - mild, isolated inflammation, 2 - moderate, localized inflammatory reaction, 3 - severe, diffuse and intense inflammatory reaction. RESULTS: The inflammatory reaction was present at the six intervals for all the tested materials, but at 12 week interval, the reaction was minimal in all cases. Also, a dissolution reaction was observed for all the materials, less intense for glass-ionomer cement and polycarboxilate cement. CONCLUSIONS: At the end of the experimental period, glass-ionomer cement and polycarboxilate cement suffered a lesser dissolution reaction as compared to the second group of tested materials.

Skeletal pattern in subjects with temporomandibular joint disorders.

INTRODUCTION: To establish the skeletal pattern in subjects with malocclusions and temporomandibular disorders (TMD); to assess the relationship between craniofacial skeletal structures and TMD in subjects with malocclusions. MATERIAL AND METHODS: Sixty-four subjects with malocclusions, over 18 years of age, were included in the study. Temporomandibular disorders were clinically assessed according to the Helkimo Anamnestic Index. Subjects underwent a lateral cephalogram. Subjects were grouped according to the sagittal skeletal pattern (ANB angle) into class I, II and III. Parametric Student tests with equal or unequal variations were used (variations were previously tested with Levene test). RESULTS: Twenty-four patients with TMD (experimental sample); 40 patients without TMD (control group); interincisal angle was higher in class I and II (p < 0.05) experimental subjects; overjet was larger in experimental subjects; midline shift and Wits appraisal were broader in the experimental group in all three classes. In class III subjects, the SNB angle was higher in the experimental group (p = 0.01). Joint noises followed by reduced mandible mobility, muscular pain and temporomandibular joint (TMJ) pain were the most frequent symptoms in subjects with TMD and malocclusions. CONCLUSIONS: Temporomandibular joint status is an important factor to consider when planning orthodontic treatment in patients with severe malocclusions; midline shift, large overjet and deep overbite have been associated with signs and symptoms of TMD.