An investigation into the impact of tooth wear on the oral health related quality of life amongst adult dental patients in the United Kingdom, Malta and Australia.

OBJECTIVE: To investigate the relationship between levels of tooth wear scored using the Basic Erosive Wear Examination (BEWE) and the impact on the quality of life of adult dental patients. METHODS: BEWE assessments were performed on 319 new dentate adult patients attending the practices of 5 trained recruiters based in primary care in Malta (120), Australia (118) or the UK (81). Oral impacts on the quality of life were measured using a shortened form of the Oral Health Impact Profile (OHIP-26). Regression analysis were performed, adjusted for age, to estimate the relationship between the variables. Data were expressed as Confidence Intervals (95 % CI), p-values (values <0.05 were considered statistically significant) and adjusted R2 values. RESULTS: Overall, the sample had a mean age of 42.6 ±â€¯17.1 (range, 18-93 years), a mean cumulative BEWE score of 6.7 ±â€¯4.4 and a mean total OHIP-26 score of 1.84 ±â€¯0.59. For the cumulative sextant BEWE scores, 68.0 % of the participants scored ≤ 8, 24.5 % between 9 and 13 and 7.5 %, ≥ 14. A significant association was found between increasing BEWE score and the overall OHIP-26 total score (effect = 0.028; p = 0.002), implying a higher BEWE to be associated with a larger impact of oral conditions on daily life. CONCLUSION: Higher levels of tooth wear were significantly associated with a deteriorating oral-health related quality of life amongst the participants. CLINICAL RELEVANCE: When treatment planning for patients with tooth wear, it is appropriate to consider the psycho-social impact of the condition alongside other clinical findings.

The restorative management of tooth wear involving the aesthetic zone.

The aim of this article is to describe a systematic approach that facilitates the establishment of a clear and appropriate diagnosis when a dentate patient presents with tooth wear involving their aesthetic zone. It will also detail the protocols that are required to allow for the development of an acceptable aesthetic prescription within the limits of the functional constraints presented by the patient (where active restorative intervention may be indicated), as well as to communicate the manner by which this information can be transferred to ultimately enable the successful and predictable rehabilitation of the affected areas. An overview will also be provided of the tooth-coloured dental materials and restorative techniques that have been commonly applied to deliver the predictable and effective dental care of worn teeth in the aesthetic zone.

A review of the longevity of effect of botulinum toxin in wrinkle treatments.

Botulinum toxin is widely used in facial rhytide treatments. The duration of its effects influences treatment intervals, cost and convenience to the patient. These are key factors in successful aesthetic procedures. A review of the literature found that duration of effect was between two and six months, with most experiencing loss of maximal contraction for three to four months. Treatments may last between three to four months, and occasionally up to six months. No specific definition of effectiveness/efficacy has been described and used to measure comparable end points. Additional research should help clarify the impact of brand, age, gender, ethnicity, repetition of treatment and zinc-phytase supplementation.

An evaluation of the influence of teeth and the labial soft tissues on the perceived aesthetics of a smile.

Objective The aim of this study was to investigate how the lips and teeth may affect the perceived aesthetics of a given smile. Lips and teeth were collectively assessed in different fields of view to see how they may contribute to smile aesthetics. The perception of 'beauty' was assessed to determine whether differences existed between; dentists, non-dentists, males and females.Methods Five subjects were photographed to produce the following views: 1) retracted anterior teeth; 2) lips at rest; 3) zoomed smile; and 4) smile showing the lower face. Images were compiled in a survey questionnaire and shown to respondents who ranked the subjects in order of aesthetic appeal. Kendall's coefficient of concordance (W) and median rank scores were used to determine the statistical significance.Results All groups demonstrated statistically significant agreement in the perception of beauty. Both the teeth and lips seemed to contribute similarly to the attractiveness of a smile. Dentists seemed to be more influenced by teeth in a zoomed smile view, however, this was negated when viewing a broader field of view. All other groups showed no difference in perception of aesthetics with changing field of view.Conclusion Both lips and teeth seem to contribute to the aesthetic appeal of a smile. Dentists may have a tendency to place a disproportionate weight to teeth when assessing a smile close up.

Simulation study of Hemodynamic in Bifurcations for Cerebral Arteriovenous Malformation using Electrical Analogy.

BACKGROUND AND OBJECTIVE: Cerebral Arteriovenous Malformation (CAVM) hemodynamic is disease condition, results changes in the flow and pressure level in cerebral blood vessels. Measuring flow and pressure without catheter intervention along the vessel is big challenge due to vessel bifurcations/complex bifurcations in Arteriovenous Malformation patients. The vessel geometry in CAVM patients are complex, composed of varying diameters, lengths, and bifurcations of various angles. The variations in the vessel diameter and bifurcation angle complicate the measurement and analysis of blood flow features invasively or non-invasively. METHODS: In this paper, we proposed a lumped model for the bifurcation for symmetrical and asymmetrical networks in CAVM patients. The models are created using MATLAB Simulation software for various bifurcation angles. Each bifurcation angle created using electrical network- RLC. The segmentation and pre-processing of bifurcation vessels are implemented using adaptive segmentation. The proposed network address clinicians problem by measuring hemodynamic non-invasively. The method is applicable for any types of bifurcation networks with different bifurcation angles in CAVM patients. RESULTS: In this work, we constructed a mathematical model, measured hemodynamic for 23 patients (actual and simulated cases) with 60 vessel bifurcation angles variations. The results indicate that comparisons evidenced highly significant correlations between values computed by the lumped model and simulated mechanical model for both networks with p < 0.0001. A P value of less than 0.05 considered statistically significant. CONCLUSION: In this paper, we have modelled different bifurcation types and automatically display pressure and flow non-invasively at different node and at different angles of bifurcation in the complex vessel with help of bifurcation parameters, using lumped parameter model. We have simulated for different bifurcation angles and diameters of vessel for various imaging modality and model extend for different organs. This will help clinicians to measure haemodynamic parameters noninvasively at various bifurcations, where even catheter cannot be reached.

The management of cracked tooth syndrome in dental practice.

Cracked tooth syndrome is a commonly encountered condition in dental practice which frequently causes diagnostic and management challenges. This paper provides an overview of the diagnosis of this condition and goes on to discuss current short and long-term management strategies applicable to dental practitioners. This paper also covers the diagnosis and management of this common condition and aims to inform clinicians of the current thinking, as well as to provide an overview of the techniques commonly used in managing cracked tooth syndrome.

A multi-centred clinical audit to describe the efficacy of direct supra-coronal splinting--a minimally invasive approach to the management of cracked tooth syndrome.

OBJECTIVES: This audit looked at the use of direct composite splinting to manage cracked tooth syndrome (CTS). METHODS: Patients who had been assessed as having CTS were offered the treatment of a directly bonded, composite overlay restoration placed in supra-occlusion. Cases were reviewed up to 3 months later. RESULTS: In all, 151 restorations were followed up in the audit of which 131 were successful at 3 months. The remaining 20 restorations failed due to pulp complications (11), failure of the composite (5) or intolerance to the high restoration (4). Of the 131, patients described transient problems with chewing (94), composite breakage (13), TMD (1), phonetics (1), increased mobility (1) and tender to chewing (1). CONCLUSIONS: This is a successful non-invasive method of managing CTS in the short term for patients willing to accept transient effects.

Current concepts on the management of tooth wear: part 4. An overview of the restorative techniques and dental materials commonly applied for the management of tooth wear.

This final article of the four part series on the current concepts of tooth wear will provide the reader with an evaluation of the data available in the contemporary literature with regards to the survival analysis of differing restorative materials, and their respective methods of application to treat tooth wear. It is vital that the dental operator is familiar with the role of differing materials which may be used to restore the worn dentition, some of which may prove to be more suitable for the management of particular patterns of tooth wear than others. The active management of tooth wear unfortunately commits the patient to a lifelong need for considerable maintenance, and it is imperative that this is understood from the outset.

Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of generalised tooth wear.

Paper 3 of this series on the current concepts of tooth wear management will focus on the provision of active restorative intervention for cases presenting with generalised tooth wear. The use of both contemporary adhesive and traditional conventional techniques applied to treat cases of generalised tooth wear will be discussed, including a consideration of the merits and drawbacks of each approach respectively.

Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear.

The aim of this series of four articles on tooth wear management is to provide the reader with the necessary information in order to be able to successfully manage cases of tooth wear, regardless of the cause, severity and location of the wear pattern seen. The content will largely focus on contemporary clinical techniques, illustrated where possible by case examples. Emphasis will be placed on 'additive adhesive techniques' utilising fixed prosthodontic protocols; however, cases of tooth wear amongst partially dentate patients involving the use of removable prostheses will also be described. The importance of patient consent and contingency planning will also be discussed. Paper 1 will describe the assessment of the wear patient, including the rationale for the planning of dental care. Also discussed will be the administration of preventative and passive management strategies for cases displaying tooth wear.

Current concepts on the management of tooth wear: part 2. Active restorative care 1: the management of localised tooth wear.

This second of the four part series of articles on the current concepts of tooth wear management will focus on the provision of active restorative care, where the implementation of a preventative, passive approach may prove insufficient to meet the patient's expectations, or indeed prove to be sufficiently adequate to address the extent of the underlying pathology to the desired level of clinical satisfaction. The active restorative management of cases presenting with localised tooth wear (of either the anterior, posterior, maxillary or mandibular variety) will be considered in depth in this paper, including a description of the commonly applied techniques and treatment strategies, where possible illustrated by case examples.

Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome.

The second of this two part series on 'cracked tooth syndrome' will focus on the available methods for the immediate, intermediate and definitive management of patients affected by this condition. Included in this article is a comprehensive account of the relative merits/drawbacks of various restorative materials and their respective techniques of application for the treatment of symptomatic, incompletely fractured posterior teeth.

Cracked tooth syndrome. Part 1: aetiology and diagnosis.

Symptomatic, incompletely fractured posterior teeth can be a great source of anxiety for both the dental patient and dental operator. For the latter, challenges associated with deriving an accurate diagnosis together with the efficient and time effective management of cases of cracked tooth syndrome are largely accountable for the aforementioned problem. The aim of this series of two articles is to provide the reader with an in-depth insight into this condition, through the undertaking of a comprehensive literature review of contemporarily available data. The first article will provide details relating to the background of cracked tooth syndrome including the epidemiology, patho-physiology, aetiology and diagnosis of the syndrome, together with a consideration of factors which may influence the prognostic outcome of teeth affected by incomplete, symptomatic fractures. The second article will focus on the immediate and intermediate management of cracked teeth, and also provide a detailed account of the application of both direct and indirect restorations and restorative techniques used respectively in the management of teeth affected by this complex syndrome.

A comparison of the survival of fibre posts cemented with two different composite resin systems.

OBJECTIVES: To evaluate the outcomes of a fibre post cemented with two different luting agents. METHODS: A single type of tooth coloured fibre post (Fibre-White Parapost, Coltene Whaledent) was used along with two different types of luting cement. A total of 129 teeth were treated in this retrospective audit: 79 treated were luted with Calibra Aesthetic Dental Resin Cement (Dentsply) and 50 with Panavia F 2.0 (Kuraray). All teeth were treated by the same operator and had a minimum ferrule of 2 mm and a ParaCore (Coltene Whaledent) composite core placed over the post. Where Calibra Aesthetic Dental Resin Cement was used, all the restorations were undertaken between June 2002 and October 2003 and were reviewed for a period of 38 to 54 months. Where Panavia had been used, all restorations were placed between February 2004 and December 2005 and reviewed for a period of 28 to 50 months. RESULTS: The results for the Calibra cemented posts were: 64 returned for recall and of these 23 were classed as failed. The causes were: root fracture (2), decementation (3), fracture at post-core interface (6), endodontic failure (8) and marginal caries (4). The results for the Panavia cemented posts were: 44 returned for recall and 9 were classed as failed; the causes of failure were fracture at post-core interface (6), endodontic failure (1) and marginal caries (2). CONCLUSIONS: For posts cemented with Calibra, a success rate of 64.1% was determined over a period of 38 to 54 months. The use of Panavia resulted in fewer post failures with a reported success rate of 79.5% over an evaluation period of 28 to 50 months. Mechanical failures by means of fractures occurring anywhere along the length of the post-core complex were the major cause of lack of success. Significantly higher failure rates were observed to occur in partially dentate patients, in those with parafunctional habits and also amongst anterior teeth. While the majority of the mechanical failures were amenable to repair, the latter mode of failure appears to be a major downfall when considering the routine use of fibre resin posts in restorative dentistry. The choice of cement appears to have a significant role in improving prognostic outcome.

Nasal hyposensitization and hay fever.

A clinical trial of pre-seasonal hyposensitization with intra-nasal grass pollen extract was carried out in forty-two patients. Results were assessed subjectively, by clinical examination during the pollen season, and by measurements of nasal air flow. Useful relief of symptoms was considered to have occurred in fifteen out of twenty-one patients who had pre-seasonal treatment with pollen extract and in five out of twenty-one patients who had similar treatment with carbol saline as a placebo. Of twelve patients who were symptom free in the pollen season ten had nasal hyposensitization. It is concluded that this simple and safe method of treatment gives results comparable with those of pre-seasonal injections.