New toothpaste to deal with dentine hypersensitivity: double-blind randomized controlled clinical trial.

OBJECTIVES: The purpose was to evaluate a combined effect of active ingredients contained in new toothpaste in reducing dentine hypersensitivity. METHODS: The tested toothpaste contained active ingredients potassium nitrate (5.00%) and zinc citrate (0.50%). Pain to water stimulus and blowing air was reported on hypersensitive teeth and measured using the VAS (Visual Analogue Scale). The degree of pain to water stimulus was detected after each subject drank a few sips of water which was boiled to the room temperature. Data were collected on each subject's dental history. RESULTS: A significant reduction in dentine hypersensitivity (26-29% after 2 weeks versus 40% after 4 weeks) was detected in the tested group. The controls also showed significant reduction to both stimuli, but at lower rate. A statistically significant difference to blowing air and water stimuli showed the highest impact for the tested group after 4 weeks (P = 0.033, P = 0.006). CONCLUSION: This study supports the efficacy of the tested toothpaste in reducing the phenomenon of dentine hypersensitivity after 4 weeks of usage.

Oral health in children with Down syndrome: Parents' views on dental care in Flanders (Belgium).

AIM: Evaluate the views and knowledge, regarding dental care, of parents who have a child with Down syndrome (DS). MATERIALS AND METHODS: Parents of children with DS were invited to fill in a questionnaire. They were recruited by the Flemish Organization for DS, from schools for children with special needs and by four multidisciplinary medical DS teams at four University Hospitals. STATISTICS: Chi-square tests were used to test the correlation between different variables. Results were assessed in the 95% confidence interval with p<0.05. RESULTS: Mean age of the children was 10.1 years old (SD: 5.3). Oral health was indicated as rather good by 53% of the parents. Of the children, 66% went to a dentist within the last six months. Most of the children (64%) received a dental examination. In 53% of the cases, parents visited the same dentist for their child with DS as their other child(ren) without DS. Eighty-three percent of the parents are pleased with their dentist. They expect the dentist to be kind and reassuring. Children aged 10 years or younger get significantly more help with tooth brushing (79%) than children older than 10 years (36%). However 20% of the parents never received any oral hygiene instructions for their child with DS. CONCLUSION: Prevention is the most frequent service provided by the dentist. Parents seem to be pleased with the dentist who treats their child with DS.

Temporomandibular disorders in young people with an intellectual disability: prevalence of signs and symptoms.

AIM: To assess the prevalence of signs and symptoms related to TMJ disorders in a group of young people with intelectual disability (ID) and a matched group of healthy adolescents. MATERIALS AND METHODS: A group of 105 young Special Olympics (SO) athletes (ID group) aged from 14 to 25 years and a control group were examined for the presence or absence of signs and symptoms of TMD through interview and clinical examination. RESULTS: A total of 64 young people with ID (61%) had at least one sign of TMD compared to 41 (39%) of the individuals screened that was free of any TMD symptoms. A significantly higher prevalence of TMJ sounds (palpation and stethoscope), TMJ tenderness, maximum vertical opening, headaches were observed among SO athletes compared to the healthy control group (p<0.05). A significant difference was recorded only for the Temporalis tenderness between the girls and boys (p<0.05). CONCLUSION: TMJ disorders are noticeable problem for intellectually disabled patients and a possible cause of pain that should be examined more in detail. We suggest that oral screening in people with a mental disability should be modified by including basic TMJ examination parameters in order to allow better understanding of the pathological aspects so as to address effective preventive and therapeutic measures.

Literature review: Restorations of class II cavities in the primary dentition with compomers.

BACKGROUND: A large number of studies concerning the use of compomers in class II cavities in the primary dentition already exist, but the variety of the research perspectives is even bigger. AIM: This study therefore intends to abridge and evaluate the existing research through a systematic literature review. METHODS: In order to gather relevant articles an extended literature research was carried out. The criteria for the evaluation of the resulting articles were based on the article of Kilpatrick and Neumann [2007]. RESULTS: According to the subject of the research, the articles were divided into the following groups: PAM-C; PAM-C and amalgam; PAM-C and GIC; PAM-C and hybrid composites; PAM-C and pre-treatment. CONCLUSIONS: The findings lead to the conclusion that PAM-C can be an alternative to other restorative materials in the primary dentition in class II cavities, except in the case of teeth with pulpectomies or pulpotomies. The placement of compomers takes longer than placing amalgam, but the procedure consists of fewer steps compared to composites. However, patient-compliance remains essential.

Dental agenesis: genetic and clinical perspectives.

Dental agenesis is the most common developmental anomaly in humans and is frequently associated with several other oral abnormalities. Whereas the incidence of missing teeth may vary considerably depending on dentition, gender, and demographic or geographic profiles, distinct patterns of agenesis have been detected in the permanent dentition. These frequently involve the last teeth of a class to develop (I2, P2, M3) suggesting a possible link with evolutionary trends. Hypodontia can either occur as an isolated condition (non-syndromic hypodontia) involving one (80% of cases), a few (less than 10%) or many teeth (less than 1%), or can be associated with a systemic condition or syndrome (syndromic hypodontia), essentially reflecting the genetically and phenotypically heterogeneity of the condition. Based on our present knowledge of genes and transcription factors that are involved in tooth development, it is assumed that different phenotypic forms are caused by different genes involving different interacting molecular pathways, providing an explanation not only for the wide variety in agenesis patterns but also for associations of dental agenesis with other oral anomalies. At present, the list of genes involved in human non-syndromic hypodontia includes not only those encoding a signaling molecule (TGFA) and transcription factors (MSX1 and PAX9) that play critical roles during early craniofacial development, but also genes coding for a protein involved in canonical Wnt signaling (AXIN2), and a transmembrane receptor of fibroblast growth factors (FGFR1). Our objective was to review the current literature on the molecular mechanisms that are responsible for selective dental agenesis in humans and to present a detailed overview of syndromes with hypodontia and their causative genes. These new perspectives and future challenges in the field of identification of possible candidate genes involved in dental agenesis are discussed.

Cranial suture biology and dental development: genetic and clinical perspectives.

Premature fusion of the calvarial bones at the sutures, or craniosynostosis (CS), is a relatively common birth defect (1:2000-3000) frequently associated with limb deformity. Patients with CS may present oral defects, such as cleft soft palate, hypodontia, hyperdontia, and delayed tooth eruption, but also unusual associations of major dental anomalies such as taurodontism, microdontia, multiple dens invaginatus, and dentin dysplasia. The list of genes that are involved in CS includes those coding for the different fibroblast growth factor receptors and a ligand of ephrin receptors, but also genes encoding transcription factors, such as MSX2 and TWIST. Most of these genes are equally involved in odontogenesis, providing a pausible explanation for clinical associations of CS with dental agenesis or tooth malformations. On the basis of the present knowledge on genes and transcription factors that are involved in craniofacial morphogenesis, and from dental clinics of CS syndromes, the molecular mechanisms that control suture formation and suture closure are expected to play key roles in patterning events and development of teeth. The purpose of this article is to review and merge the recent advances in the field of suture research at the genetic and cellular levels with those of tooth development, and to apply them to the dental clinics of CS syndromes. These new perspectives and future challenges in the field of both dental clinics and molecular genetics, more in particular the identification of possible candidate genes involved in both CS and dental defects, are discussed.

Review: finishing and polishing procedures of (resin-modified) glass ionomers and compomers in paediatric dentistry.

BACKGROUND: A smooth surface has a beneficial effect on the aesthetic quality and longevity of a dental restoration, as well as on its biocompatibility with oral tissues. In this review studies on glass-ionomer cements (GIC), resin-modified glass-ionomer cements (RM-GIC), and compomers or polyacid-modified resin composites (PAM-C) were assessed as these are currently used in paediatric dentistry. METHOD: Medline databases (USA National Library of Medicine) was searched using WinSpirs and Pubmed. This search used a keyword filter including dental materials, polishing procedures, and instrumentation including influencing factors. FINDINGS: Although the literature shows different commercially available tools it seems that the ideal polishing instrumentation in paediatric dentistry for GIC and compomers is not yet on the market. Furthermore, the constant development of dental materials and polishing products impose a need for continuous scientific research.

Dentinogenesis imperfecta associated with short stature, hearing loss and mental retardation: a new syndrome with autosomal recessive inheritance?

The follow-up history and oral findings in two brothers from consanguineous parents suggest that the association of dentinogenesis imperfecta (DI), delayed tooth eruption, mild mental retardation, proportionate short stature, sensorineural hearing loss and dysmorphic facies may represent a new syndrome with autosomal recessive inheritance. Histological examination of the dentin matrix of a permanent molar from one of the siblings reveals morphological similarities with defective dentinogenesis as presenting in patients affected with Osteogenesis Imperfecta (OI), a condition caused by deficiency of type I collagen. A number of radiographic and histological characteristics, however, are inconsistent with classical features of DI. These findings suggest that DI may imply greater genetical heterogeneity than currently assumed.

Effect of a neutral citrate solution on the fluoride release of resin-modified glass ionomer and polyacid-modified composite resin cements.

The effect of 0.01 mol/l citrate solution at pH = 7 on the fluoride release is compared for the resin-modified glass ionomer cements (RM-GIC) GC Lining LC, PhotacBond, Vitremer and Vitrebond and for the polyacid-modified composite resins (PAM-C) Variglass and Dyract by means of the six-month fluoride release profiles at 37 degrees C. The fluoride release of both RM-GIC and PAM-C increases in the neutral citrate solution as compared to water, which can be explained by the ability of citrate to complex metal ions and hence to degrade the glass as well as the polysalt matrix of the cement. Although RM-GIC release more fluoride than PAM-C in water as well as in citrate solution, the relative increase in fluoride release upon immersion in citrate solution is most pronounced for PAM-C. Whereas for the latter citrate affects both the short-term and long-term fluoride release, for RM-GIC only the long-term fluoride release is affected. This suggests that the action of citrate increases with decreasing importance of the polysalt formation in the hardening of the material. This could be explained on the basis of the difference in the chemical properties of the cement matrix.

Optimizing cuff width for noninvasive measurement of blood pressure.

BACKGROUND: It is well established that indirect measurements of blood pressure made with a standard 13cm-wide cuff are erroneously high for large arms and low for small arms. To correct for this error, the American Heart Association recommends adjusting cuff width to 40% of the arm's circumference. OBJECTIVE: To test the validity of this method of correction. DESIGN: This study was a prospective, nonblinded, paired Student's t-test analysis. METHODS: Blood pressures in 50 subjects were measured directly by using a radial artery line and indirectly by the Korotkov method. For each subject multiple indirect measurements of blood pressure were made with the cuff width:arm circumference ratio varied from 30-55% in 5% increments. Error was defined as indirect blood pressure minus direct blood pressure. RESULTS: A ratio of 40% resulted in overestimation of blood pressure for most arms and with particularly high errors for small arms. The ratio producing zero mean error for the pooled study group was 46.4+/-0.7% (mean+/-SEM). Using this ratio of 46.4%, the error varied inversely with arm circumference (P<0.02), resulting in overestimation of systolic blood pressure for small arms and underestimation of systolic blood pressure for large arms. This error is comparable in magnitude, but opposite in sign, to that which occurs with a standard 13cm-wide cuff for all arms. The optimum ratio was found to be closely approximated by the relationship, cuff width=9.34 log(10) arm circumference. Using this relationship, error in systolic blood pressure was insensitive to arm circumference (r=0.04, P>0.05) and near zero. CONCLUSION: The optimum cuff width for the indirect measurement of blood pressure is not directly proportional to arm circumference, but is proportional to the logarithm of the arm's circumference.

Effect of maturation on the fluoride release of resin-modified glass ionomer and polyacid-modified composite resin cements.

The effect of an early water contact on the fluoride release is studied for the resin-modified glass ionomer cements (RM-GIC) GC Lining LC, PhotacBond, Vitremer and Vitrebond and for the polyacid-modified composite resins (PAM-C) Variglass and Dyract. Six months fluoride release profiles were determined in regularly renewed water (37 degrees C), for the products directly after light curing and after 24 h maturation in a humid atmosphere (85% RH). ANOVA shows that both the short-term and the long-term fluoride release of a RM-GIC are influenced by this maturation. This indicates that direct water contact for this material should be avoided. For the RM-GIC a correlation is found between the initial fluoride release process and the long-term process. For the PAM-C materials, no differences in the fluoride release are found as a function of maturation, indicating that early water contact has no effect. The amounts of fluoride released by PAM-C are low compared to RM-GIC, which can affect their caries preventive potential. The results are explained on the basis of the setting reaction of both types of materials.

Ketac Molar Versus Dyract Class II restorations in primary molars: twelve month clinical results.

The aim of the present clinical study was an in vivo evaluation of an improved conventional glass ionomer cement Ketac Molar (ESPE), compared to a polyacid modified composite resin, Dyract (Dentsply/De Trey), used in primary molars. Fifty-three Ketac Molar and fifty-two Dyract restorations were placed in box-only preparations in primary molars. The application time for the chemically cured Ketac Molar, was longer compared to the light-cured Dyract. In comparing the materials, no differences were found, comparing both materials regarding secondary caries, marginal adaptation, wear and fracture toughness. One case of recurrent caries adjacent to a Ketac Molar restoration and two cases in the Dyract group were reported. Two Ketac Molar restorations and one Dyract showed bulk fracture at the time of evaluation. At the twelve-month evaluation, no difference between the investigated materials was registered, which indicates that Ketac Molar can be used as a proximal restoration in the primary dentition. It should be emphasized, however, that one-year data should not be extrapolated to indicate the long-term success of restorations.

Dyract versus Tytin Class II restorations in primary molars: 36 months evaluation.

Due to the changed treatment approach of proximal caries and the amalgam controversy, clinicians are in search for new materials. The aim of the present study was to compare amalgam with an adhesive material in deciduous molars in a clinical, split-mouth design study. At baseline 30 polyacid modified composite (Dyract) and 30 amalgam (Tytin) restorations were placed in primary molars, of which 24 and 17 could be evaluated after 24 and 36 months, respectively. Modified USPHS criteria were used for clinical evaluation every 6 months. Annual bite-wing radiographs were taken for evaluation of recurrent caries and cervical gap formation. In the present study, for Dyract as well as for Tytin restorations, low rates of recurrent caries were found, while Dyract restorations showed a better marginal adaptation and surface texture compared to Tytin restorations. In the Dyract group more radiolucencies were found at baseline. In both groups no patient complaint or pain was reported related to the radiolucencies. After 3 years the colour of Dyract was not comparable to the original. For Dyract no excessive wear was noticed compared to enamel. During the study one Dyract (recurrent caries: 18 months) and two Tytin (pulpal aetiology: 6 months, recurrent caries: 36 months) restorations had to be replaced. Even though the restorations were placed in caries risk children, at the 36 months' evaluation of this clinical study, the results indicate that Dyract can be an alternative for Tytin in the primary dentition.

Conservative interproximal box-only polyacid modified composite restorations in primary molars, twelve-month clinical results.

The treatment of proximal caries has changed during the last decade. The present study evaluates a recently developed material, applied in box-only preparations in primary molars. At the twelve-month evaluation of this clinical study, it became obvious that Dyract can be an alternative for Tytin in the primary dentition, though there is some change in color of the Dyract material. In time, the marginal adaptation of Dyract seems to improve. The preparation time for both materials is comparable. The total treatment time of box-only Dyract restorations (including an occlusal sealant), however, is longer compared to conventional class II Tytin restorations. Although in both groups radiolucencies were found at the baseline radiograph evaluation, no sign was found of secondary caries. One recurrent caries lesion was found adjacent to a Dyract restoration. It should be emphasized that one-year data do not indicate the longterm success of restorations.

Fluoride release process of (resin-modified) glass-ionomer cements versus (polyacid-modified) composite resins.

The fluoride release of conventional and resin-modified glass-ionomers is reviewed and compared to that of fluoride-releasing (polyacid-modified) composite resins. Each formulation displays a typical fluoride release profile. The cumulative amount of fluoride released is described by [F]c = [F](I)t/(t + t1/2) + beta square root t for glass ionomers whether resin-modified or not, whereas for composite resins this quantity is given by [F]c = [F](I)t/(t + t1/2) + alpha t. Both equations indicate that two kinetic processes are responsible for the fluoride release profiles. The kinetic parameters [F](I), t1/2, beta and alpha depend on the formulation. On the basis of the exchange characteristics for fluoride, an attempt is made to explain the mechanisms responsible for these fluoride release processes.

[Use of fluorides in children: recommendations of the European Academy for Pediatric Dentistry]. / Utilisation du fluor chez les enfants: recommandations de l'European Academy for Paediatric Dentistry (EAPD).

The European Academy of Paediatric Dentistry (EAPD) strongly endorses that fluoride use should be part of any preventive programme for the control of dental caries in children. Each child under the care of a dentist should have a carefully planned programme appropriate to the level of caries risk and age of each child. Such a preventive programme should be reevaluated at least every six or 12 months and changed according to the patient's risk and the improvement or not of his or her's overall health. It is the combination of the use of an appropriate fluoride toothpaste with good oral hygiene that is the key to good dental health. This policy document deals with guidelines for systemic use of fluorides, fluoride supplements, topical methods (varnishes, mouthrinses and gels) and toothpastes. Moreover some recommendations are given to toothpaste manufacturers.

Evaluation of magnetic resonance imaging in coarctation of the aorta: the importance of multiple imaging planes.

Coarctation of the aorta can be evaluated reliably and noninvasively by magnetic resonance imaging. However, the value of different imaging planes in the evaluation of restenosis or aneurysm has not previously been studied. Our purpose was to study the relative sensitivity for oblique coronal and oblique parasagittal magnetic resonance imaging to detect restenosis or aneurysm formation in children following surgical repair or balloon angioplasty of coarctation of the aorta. The study included magnetic resonance imaging studies in 27 children. Each exam included ECG gated, spin-echo imaging in oblique coronal and oblique parasagittal planes. Recoarctation was defined as a greater than 50% narrowing of the aorta. Aneurysms were defined as focal dilatation of the aorta in the region of coarctation 20% or greater than the adjacent aortic diameter. Recoarctation was detected in 11 children, but in both views in only five children. Aneurysms were detected in 15 children, but in both views in only three children. Recoarctation and aneurysm detection were both statistically more likely to be detected if oblique coronal and oblique parasagittal views were obtained, indicating that multiple imaging planes are necessary to completely evaluate magnetic resonance imaging of coarctation.