Burden of oral diseases and impact of protracted displacement: a cross-sectional study on Syrian refugee children in Lebanon.

Introduction Very little is known about the burden of childhood oral diseases in protracted humanitarian settings.Aim This study aimed to assess the prevalence of oral diseases in Syrian refugee children living in Lebanon and to investigate their relationship with the duration of displacement.Methods Data from Miles for Smiles programme for Syrian refugee schoolchildren in Bekaa/Lebanon were used (n = 823). A dental examination was performed to assess the presence of dental caries and abscess. A clinical form was used to collect data on the presence, intensity and duration of dental pain.Results The majority (90%) had dental caries, 57% had dental pain (of which 55% had moderate/severe pain and 38% had pain for more than a month) and 9% had dental abscess. After adjusting for age and gender, children in protracted displacement were significantly more likely to have a higher number of decayed teeth compared to their counterparts who had been displaced for less than five years (RR = 1.19; 95% CI = 1.09-1.29; P <0.001).Conclusions The burden of oral diseases in Syrian refugee children living in Lebanon was high, particularly among those living in a protracted situation. There is a need for evidence-based effective public health interventions to improve this population's oral health.

An evaluation of 10 percent and 20 percent benzocaine gels in patients with acute toothaches: efficacy, tolerability and compliance with label dose administration directions.

BACKGROUND: The authors evaluated the efficacy and tolerability of 10 percent and 20 percent benzocaine gels compared with those of a vehicle (placebo) gel for the temporary relief of toothache pain. They also assessed the compliance with the label dose administration directions on the part of participants with toothache pain. METHODS: Under double-masked conditions, 576 participants self-applied study gel to an open tooth cavity and surrounding oral tissues. Participants evaluated their pain intensity and pain relief for 120 minutes. The authors determined the amount of gel the participants applied. RESULTS: The responders' rates (the primary efficacy parameter), defined as the percentage of participants who had an improvement in pain intensity as exhibited by a pain score reduction of at least one unit on the dental pain scale from baseline for two consecutive assessments any time between the five- and 20-minute points, were 87.3 percent, 80.7 percent and 70.4 percent, respectively, for 20 percent benzocaine gel, 10 percent benzocaine gel and vehicle gel. Both benzocaine gels were significantly (P ≤ .05) better than vehicle gel; the 20 percent benzocaine gel also was significantly (P ≤ .05) better than the 10 percent benzocaine gel. The mean amount of gel applied was 235.6 milligrams, with 88.2 percent of participants applying 400 mg or less. CONCLUSIONS: Both 10 percent and 20 percent benzocaine gels were more efficacious than the vehicle gel, and the 20 percent benzocaine gel was more efficacious than the 10 percent benzocaine gel. All treatments were well tolerated by participants. Practical Implications. Patients can use 10 percent and 20 percent benzocaine gels to temporarily treat toothache pain safely.

One-year re-entry results of guided bone regeneration around immediately placed implants with immediate or conventional loading: a case series.

OBJECTIVE: The aim of this one-year, re-entry case series was to evaluate clinically the amount of bone regeneration following the placement of immediate implants in fresh extraction sockets where bone allograft has been used to treat horizontal gaps and buccal-bone dehiscence defects in periodontally compromised patients. METHODS: Sixteen patients consented to participate, each having one immediate implant with > 3 mm buccal dehiscence bone defects and > or = 2 mm horizontal defects between the implant and socket wall. Peri-implant defects were treated using a demineralized freeze-dried bone allograft and a bioresorbable collagen membrane. Measurements of the vertical and horizontal bone defects were performed at 4 sites: buccally, mesially, distally and lingually, and were done at baseline and at 1-year follow-up. RESULTS: The mean reduction in vertical defects between baseline and re-entry for all sites was 2.42 mm (p = 0.0005). Compared to lingual sites, the buccal sites showed the greatest resolution in vertical defects dimension (6.37 mm), followed by proximal sites (0.78 mm). The overall mean reduction in horizontal defects was 1.59 mm (p < 0.0001). Compared to lingual sites, the buccal sites showed the greatest resolution in horizontal gap dimension (3.2 mm), followed by proximal sites (0.8 mm). Age, defect location in the mouth and implant length did not show significant effectson the reduction in defect dimension during the first year. CONCLUSIONS: A partially missing buccal plate was not a critical factor for implant success and bone regeneration of immediate implants in patients with a history of periodontal disease regardless of the time of implant loading (immediate/conventional).

Immediate implants with immediate loading vs. conventional loading: 1-year randomized clinical trial.

PURPOSE: This 1-year randomized clinical trial compared the bone regeneration and success rates between immediate and conventional loading of dental implants placed immediately after extraction in patients with a past history of periodontal disease. METHODS: Sixty patients who chose an immediate implant treatment option to replace a hopeless tooth were included in this study. PATIENTS: Patients were randomly assigned to receive immediate implants with either immediate loading (group A) or conventional loading after 3 months (group B). At baseline, both groups received a mucoperiosteal flap, extraction, implant placement, allograft bone, and a membrane. Group A received a provisional crown. In group B, a cover screw was placed and primary closure was achieved. The patients were evaluated at 3, 6, and 12 months postoperatively. RESULTS: The 1-year implant survival rate was 95% for the whole study group: 96.6% for group A, and 93.3% for group B. The bone level increased significantly in both groups (group A: 0.99 ± 0.22 mm; group B: 0.75 ± 0.17 mm), and the difference was not statistically significant (p > 0.5). At the 1-year postoperative visit, the mucogingival junction (MGJ) was found to be displaced coronally in 65% of implant sites in group B compared with 15% sites in group A. CONCLUSIONS: Both the immediate and delayed loading of immediately placed implants showed similar outcome with regards to treatment success rates and stability of radiographic bone level. Submerging an immediately placed implant and primary soft tissue closure did not show significant outcome advantages over the transmucosal approach.

Bone regeneration around implants in periodontally compromised patients: a randomized clinical trial of the effect of immediate implant with immediate loading.

BACKGROUND: This 2-year randomized clinical trial compared bone regeneration and esthetic outcome between immediate and conventional loading of dental implants placed immediately after extraction in patients with a history of periodontal disease. METHODS: Patients were randomly assigned to receive immediate implants with either immediate loading or conventional loading after 3 months. Both groups received a periodontal flap, tooth extraction, implant placement, allograft bone, and membrane placement. The immediate loading group received a temporary crown. In the conventional loading group primary closure was achieved. All patients were followed up at 3, 6, 12, and 24 months. Evaluation included radiographic bone changes, papillary esthetic outcome, and implant survival rate. RESULTS: Seventy-two patients were recruited into the study. However, 60 patients received immediate implant placement after extraction: 30 with conventional loading and 30 with immediate loading. In the immediate loading group the implant survival rate at 2 years was 96.7%, and the mean bone gain was 1.19 mm. The corresponding figures in the conventional loading group were 93.3% and 1 mm. The gain in bone level occurred mainly from baseline to 1 year postoperatively in both groups (P <0.001). The papilla index decreased from baseline to 1 year in both groups (P <0.001) and changed only slightly thereafter. There were no significant differences between the two groups in the amount of bone gain or papilla index change during 2 years. CONCLUSIONS: Immediate loading of a single implant placed in a fresh extraction site in periodontally compromised patients resulted in similar bone gain and soft tissue esthetic outcomes compared to delayed loading. Primary closure and delayed loading to ensure bone regeneration around implants were not critical in this study.

Osseous grafting part I: autografts and allografts for periodontal regeneration--a literature review.

Osseous grafting represents one mode of therapy to manage periodontal osseous defects. Materials for osseous grafting can be obtained from the same person (autografts), from a different person of the same species (allografts), from a different species (xenografts), or from synthetic materials (alloplasts). The two types of grafts most frequently used in periodontal therapy are autogenous grafts and allografts. Both types can be obtained either intraorally or extraorally. They may be cancellous bone, cortical bone, or combinations of these. There has been a recent increase in interest in using xenografts and alloplasts. Bone graft materials are generally evaluated based on their osteogenic, osteoinductive, or osteoconductive potential. Selection of graft material is based on operator preference, type and size of the defect, resorbability of graft material, cost and patient acceptance. In this review we discuss criteria for selection of graft material, factors influencing bone graft success, autografts and allografts.

Osseous grafting part II: xenografts and alloplasts for periodontal regeneration--a literature review.

Osseous grafting represents one mode of therapy to manage periodontal osseous defects. Materials for osseous grafting can be obtained from the same person (autografts), from a different person of the same species (allografts), from a different species (xenografts), or from synthetic materials (alloplasts). The two types of grafts most frequently used in periodontal therapy are autogenous grafts and allografts. Both types can be obtained either intraorally or extraorally. They may be cancellous bone, cortical bone, or combinations of these. There has been a recent increase in interest in using xenografts and alloplasts. Bone graft materials are generally evaluated based on their osteogenic, osteoinductive, or osteoconductive potential. Selection of graft material is based on operator preference, type and size of the defect, resorbability of graft material, cost and patient acceptance. In this review we discuss different types of xenografts and alloplasts, and the advantages and disadvantages of each type.

Effect of tobacco counseling by dental students on patient quitting rate.

Tobacco use has widespread, devastating effects on the body, including the oral cavity. Today's dental professional must be trained to counsel patients on tobacco cessation, but dental health professionals and students do not feel confident in their counseling abilities. The University at Buffalo School of Dental Medicine (SDM) established the Tobacco Counseling Cessation Protocol (TCCP), which was implemented in the dental curriculum, and dental students were trained in its use. The goal of this project was to assess the effectiveness of the TCCP by surveying both patients and dental students. Students and patients were contacted to determine the effect of the TCCP on the quitting rate. Third- and fourth-year dental students were surveyed through the school e-mail system and asked to report on their tobacco cessation counseling practices. Patients who received TCCP received follow-up telephone calls to obtain their input on the program and also to determine if they had quit. According to the follow-up survey, 14 percent of patients reduced the number of cigarettes smoked per day, and 22 percent quit entirely. Fifty-one percent of those who received the TCCP made a commitment to quit at the time of the intervention; 32 percent of those receiving the TCCP were still smoke-free at six months, but 19 percent had returned to smoking. If predoctoral students receive appropriate training, they can be effective in motivating patients to quit smoking. Dental students are generally receptive to the educational material on tobacco use and smoking cessation counseling, yet only half report routinely implementing the TCCP. More needs to be done to incorporate tobacco cessation counseling into routine dental care. The culture of dentistry must be changed to view tobacco use as a dental problem.

Resolution of oral lesions after tobacco cessation.

BACKGROUND: Dentists and other health care professionals are familiar with the impact of tobacco on oral and general health. However, oral health care professionals do not often provide tobacco-cessation counseling to their patients, thus reflecting a significant disconnect between research and clinical practice. This report demonstrates the benefits of tobacco cessation in resolving oral lesions and improving overall periodontal and oral health. METHODS: A 51-year-old white male presented to the University at Buffalo, School of Dental Medicine clinic requesting an oral and periodontal examination as part of a presurgical protocol prior to cardiac surgery. A review of the patient's history from a health questionnaire revealed that he was using smokeless tobacco every day. An oral examination revealed several white lesions (5 x 10 mm) on the maxillary right and left labial mucosa. The patient was provided with tobacco-cessation counseling as well as oral hygiene instructions and professional dental prophylaxis. RESULTS: An oral examination 2 weeks after tobacco cessation revealed complete resolution of the oral lesions and overall improvement of periodontal and oral health. CONCLUSION: Although the findings presented in this article are based only on a single case report, the improvement in the patient's oral health after cessation of tobacco use was dramatic and reinforces the belief that tobacco-cessation counseling should be a routine component of the standard of care for tobacco-using patients.