Burden of oral disease in the Middle East: Opportunities for dental public health.

A significant increase in the burden of oral-health related diseases in the Middle East has been observed recently. This increase has been largely the result of poor awareness concerning the importance of oral health and best practices towards achieving good oral hygiene. Contributing factors to this burden include but are not limited to: increased sugar consumption, inadequate oral hygiene practices and a high prevalence of smoking. All these factors are known to have considerable influence on the development of the most common oral diseases, such as dental caries, periodontal diseases, oral precancerous lesions and cancer. Although oral diseases represent a significant burden on the quality of life and healthcare economics of Middle Eastern countries, restorative and preventive dental care have not been given nearly enough attention. The prevention of dental diseases is critical to preserving not only oral health but also to maintaining general well being. This Supplement will address the need for oral disease preventative approaches with the use of epidemiological data, and will focus on the management and prevention of dental caries and periodontal disease, providing practical advice on for the management of plaque biofilm. There is a significant need for increased public awareness and regular surveillance of oral hygiene practices in the Middle East, as well as the complications associated with poor oral hygiene. In addition, development of guidelines, public health awareness programmess and dental community educational programmes are urgently needed.

Improving oral health in the Middle East - recommendations from the first Middle East Oral Hygiene Advisory Board meeting.

Chronic periodontitis may be a sequela of chronic gingivitis, usually because of accumulation of plaque and calculus. Consistent good dental hygiene can help prevent gingivitis and periodontitis. Mechanical removal of plaque through frequent and efficacious brushing and flossing is the principal means of preventing periodontal diseases and diminishing the risk of caries. According to the American Dental Association (ADA), antimicrobial mouth-washes may provide additional oral health benefits, in addition to brushing and flossing, for preventing and reducing gingivitis and plaque. There is a multitude of mouthwashes available for these purposes. The consensus panel of the Middle East Oral Hygiene Advisory Board has recommended that an antiseptic mouthwash should be used as a daily adjunct to mechanical cleaning for prevention of oral disease. Recommending particular mouthwashes should take into consideration the patient's ability to perform good oral hygiene practices (tooth brushing and dental flossing), the condition of the patient's teeth, gingivae and oral mucosa, and the proven efficacy of the mouthwash along with its potential adverse effects. Of the many mouth rinses available, only a few contain chemical agents that have some ability to penetrate biofilm and to kill plaque biofilm bacteria. Currently, only chlorhexidine mouthrinse and Listerine (an essential oil-containing mouth rinse) products, with the claim of plaque and gingivitis reduction, have been accepted for that purpose by the ADA and have a proven record of safety and efficacy. Essential oil-containing mouthrinses have been clinically proven as effective in reducing plaque and gingivitis. Dental care professionals should spend time discussing biofilm control with their patients, and be an information source for the best oral care products. Therefore, it is essential that dental care professionals should continue to monitor published research and work with their colleagues to make evidence-based decisions. In this way, patients will be directed to dental hygiene aids, including antiseptic mouthwashes that can be most effective for improving their oral health.

Occlusal plane discrepancies generated by transverse horizontal axis deviations.

STATEMENT OF PROBLEM: Any deviation from the patient's rotational axis of the mandible during closure and the arc of closure on an articulator has been reported to produce occlusal discrepancies. These discrepancies can affect diagnostic planning procedures and the occlusal relationships of restorations. PURPOSE: This study investigated the magnitude and types of occlusal errors produced by deviations between the patient's transverse horizontal axis and the axle on the articulator. MATERIAL AND METHODS: A simplified monoplane model was diagrammatically analyzed for deviations from the model's true transverse horizontal axis. Axis deviations of 5 mm were used in 8 different directions from the true transverse horizontal axis of the model. Changes in the orientation of the mandibular plane to the maxillary plane were illustrated diagrammatically. These changes were quantified by geometric and trigonometric assessments. RESULTS: All axis deviations produced mandibular plane orientation errors with angular plane malalignment to the maxillary plane on complete closure. These axis deviations also produced anterior-posterior shifting of the mandibular plane relative to the maxillary plane. CONCLUSION: Several different types of planar shifting and angular discrepancies were demonstrated from deviations away from the true transverse horizontal axis.

New abutment for a screw-retained, implant-supported crown.

The 1-piece, implant-supported abutment and crown, colloquially described as the UCLA abutment, commonly is used to fabricate single, screw-retained crowns. This abutment was designed to allow attachment of the crown directly to the implant and requires a waxing and casting procedure by a laboratory technician. A new prefabricated abutment has been developed that uses a similar approach but does not require the waxing and casting process. The PDQ abutment is made from a metal-ceramic alloy that is custom contoured by grinding to support a porcelain veneer. Porcelain then is fired to the contoured abutment to develop the 1-piece artificial crown. This article describes the use of the PDQ abutment.

Foundation restorations in fixed prosthodontics: current knowledge and future needs.

PURPOSE: The Ad Hoc Committee on Research in Fixed Prosthodontics established by the Academy of Fixed Prosthodontics publishes a yearly comprehensive literature review on a selected topic. The subject for this year is foundation restorations. METHODS: Literature of various in vitro and in vivo investigations that included technical and clinical articles was reviewed to provide clinical guidelines for the dentist when selecting methods and materials for restoration of structurally compromised teeth. Topics discussed and critically reviewed include: (1) desirable features of foundation restorations, (2) foundations for pulpless teeth, (3) historic perspectives, (4) cast posts and cores, (5) role of the ferrule effect, (6) prefabricated posts, (7) direct cores, (8) foundation restorations for severely compromised teeth, (9) problems and limitations, (10) future needs, and (11) directions for future research. CONCLUSION: This comprehensive review brings together literature from a variety of in vitro and in vivo studies, along with technique articles and clinical reports to provide meaningful guidelines for the dentist when selecting methods and materials for the restoration of structurally compromised teeth.

Investigation of the effect of three sprue designs on the porosity and the completeness of titanium cast removable partial denture frameworks.

STATEMENT OF PROBLEM: Although titanium has been used to cast removable partial denture frameworks, the casting process is arduous and requires specialized equipment. PURPOSE: This study evaluated the ability of 3 sprue designs (tree, ball, and circular) to produce complete, void-free castings of removable partial denture frameworks made from commercially pure titanium. METHODS AND MATERIAL: A cast with a Kennedy class III, modification 1, partially edentulous arch was used. The blocked-out cast was modified to facilitate assessment of the completeness of the casting of the clasp arms. Thirty refractory casts were made, and 10 wax patterns for each sprue design were fabricated and invested with ethyl silicate investment. Castings were made with an arc-type automatic casting machine in an argon atmosphere. Castings were examined with radiographic equipment to detect the presence of voids in the castings, and the completeness to each casting was visually verified. Data on porosities were tabulated and statistically analyzed with 1-way ANOVA followed by Student Newman-Keuls test. Chi-square analysis was used to identify statistically significant differences in casting defects among the 3 sprue designs. RESULTS: No statistically significant differences in the total number of porosities were found between the 3 sprue designs (P =.51). Results of completeness of castings evaluated by using chi-square test revealed a statistically significant deference among the 3 sprue designs (P =.008). CONCLUSION: The ball-sprue design produced the most complete castings for the removable partial denture titanium frameworks.

An in vitro study of the fracture resistance and the incidence ofvertical root fracture of pulpless teeth restored with six post-and-coresystems.

STATEMENT OF PROBLEM: Posts and cores are often required with pulpless teeth to provide retention and resistance form for complete crowns. Nevertheless, conventional posts may increase the potential for root fracture. PURPOSE: This study compared the resistance to vertical root fracture of extracted teeth treated with post-core systems that were modified with polyethylene woven fibers (Ribbond) with those treated with conventional post-and-core systems. MATERIAL AND METHODS: Canal instrumentation was performed for 60 maxillary central incisors, and complete crown preparations were made. The coronal portion of each tooth was amputated, and 6 post-and-core systems were studied. Specimens were mounted in acrylic resin blocks with a layer of polyvinyl siloxane covering the roots. Loads were applied at an angle of 130 degrees and measured with a universal testing machine. Results were analyzed statistically with 1-way analysis of variance with Student-Newman-Keuls grouping and chi-square analysis. RESULTS. Cast posts and cores resulted in significantly higher failure thresholds than all others, except for prefabricated, comparably sized, parallel-sided posts with composite cores. All failures in the group with cast posts involved fracture of the teeth, whereas 70% of the teeth with comparably sized parallel-sided posts and composite cores failed as a result of tooth fractures and 30% experienced core fractures. The woven fiber post-core system was significantly lower in strength than all others, and exhibited significantly fewer vertical root fractures. CONCLUSIONS: Polyethylene woven fiber and composite resin without a prefabricated post resulted in significantly fewer vertical root fractures, but mean failure load was the lowest. Smaller diameter prefabricated posts combined with the polyethylene woven fiber and composite cores improved resistance to failure. Traditional cast posts and cores were the strongest of the 6 post-core systems.

Programmed tooth preparation for fixed partial dentures.

This article describes a method for efficient and precise tooth preparation for fixed partial dentures. Diagnostic procedures are also reviewed.

The effect of temperature changes on the dimensional stability of polyvinyl siloxane and polyether impression materials.

STATEMENT OF PROBLEM: Dental impressions are commonly mailed to remote dental laboratories and can be subjected to extreme temperature changes; however, the effects of these temperature changes on the accuracy of elastomeric impression materials are unknown. PURPOSE: This study evaluated the dimensional changes of polyether and polyvinyl siloxane impression materials as a function of storage temperature. MATERIAL AND METHODS: A total of 144 impressions were made of a stainless steel die similar to ADA Specification No. 19. Half of the impressions were made in perforated custom trays and the other half in solid trays. Measurements of the vertical and horizontal lines on the impressions were made at 10 minutes, 1 hour, 24 hours, and 26 hours, and storage temperatures ranged from 4 degrees C to 40 degrees C. RESULTS: Changes in storage temperature had a statistically significant effect on the dimensional stability of the horizontal and vertical lines. However, overall dimensional changes were extremely small. CONCLUSIONS: Storing both impression materials at 4 degrees C for 24 hours and then allowing the impressions to reach room temperature resulted in a slightly expanded impression that partially compensated for the contraction that occurred from polymerization shrinkage. Similar results occurred for polyether material only, when stored at 40 degrees C.

Use of aluminum strips to fabricate verification jig for an implant-supported fixed partial denture.

Verification of the accuracy of the master cast for an implant-supported fixed partial denture will reduce the chair time and laboratory costs of implant prosthodontic treatment. A wire is usually luted in the mouth to machined components that have been secured to the implants, and the luted assembly is then transferred to the cast to evaluate the positional accuracy of the implant analogs. Unless this wire is dead soft, inaccuracies as a result of elastic memory of the wire can occur. Also, if the wire is not completely rigid, it can be distorted during handling. This article describes a more reliable verification jig for an implant-supported fixed partial denture that can be fabricated with 1.5 mm thick aluminum strips that are luted to the implant components. The use of two aluminum strips creates a metal framework that is rigid and not easily distorted. Also the aluminum pieces do not have elastic memory because they were cut and not bent to shape.

A procedure for making an interocclusal record without the use of record bases for a combined fixed/removable prosthesis.

This article describes a procedure for making an interocclusal record for a remount procedure after tryin of the castings. This method can also be used for the initial mounting by substituting autopolymerizing acrylic resin copings for the metal castings.

Four uses of a disposable implant mount.

The high cost of precision-fitting, machine-milled implant components is a major concern, and the dentist with a busy implant practice must stock numerous components at considerable expense. In this article, the use of a disposable implant mount is described as an adjunct for a positional index during stage-I surgery, immediate provisional restoration at stage-II surgery, verification jig, and implant-supported record base. By reusing the precision-fitting implant mount that is supplied free of charge by the manufacturer, the dentist can reduce the overhead costs required to provide implant prosthodontic treatment.

Vacuum-formed matrix as a guide for the fabrication of multiple direct patterns for cast posts and cores.

Fabrication of multiple posts and cores for severely damaged pulpless teeth is arduous because few landmarks remain. Esthetic requirements, occlusal relations, and long axes of the planned final restorations influence the core design. This article describes a method for directly verifying fabricated post-and-core patterns by combining the procedures for making a thermoformed shell for a preparation template and creating a plastic template for multiple core pattern fabrication.

Effects of chemical disinfectant solutions on the stability and accuracy of the dental impression complex.

Currently available impression materials were not designed for disinfection or sterilization, and it is conceivable that disinfectants may adversely affect impressions. This study evaluated the accuracy and dimensional stability of polyether (Permadyne/Impregum) and polyvinyl siloxane (Express) impression materials retained by their adhesives in two different acrylic resin tray designs (perforated and nonperforated) when the materials were immersed for either 30 or 60 minutes in three high-level disinfectants. Distilled water and no solution served as controls. A stainless steel test analog similar to ADA specification No. 19 was used. A total of 400 impressions were made with all combinations of impression materials, tray designs, disinfectant, and soaking times. Samples were evaluated microscopically before and after immersion and 48 hours after soaking. Results indicated that these two impression materials were dimensionally stable. Because the results emphasized the stability and accuracy of the impression complex under various conditions, dentists can perform disinfection procedures similar to the protocol of this study without concern for clinically significant distortion of the impression.

Complete edentulism and denture use for elders in New England.

The purpose of this study was to collect information about the oral health of a representative group of elders in the New England states. This study provides the most current descriptive analysis of completely edentulous noninstitutionalized elders to date. In-home examinations and interviews were conducted for a representative sample of elders over 70 years of age. The oral examinations and interviews were conducted by calibrated dentists and trained interviewers, respectively. Of 1156 study participants, 424 (36.7%) were edentulous. Edentulous rates were similar for men and women and were negatively related to levels of education and income. Of the completely edentulous individuals, 89.9% had maxillary and mandibular complete dentures. Most of these dentures (83.2%) were worn during the day. More than one third of the respondents reported wearing one or both of their dentures while sleeping at night. For 77 of the completely edentulous individuals, examination revealed denture irritations, most of which were on the hard palate.