Aggressive periodontitis in a Nigerian teaching hospital.

AIM: These case series were aimed at highlighting late presentations of aggressive periodontitis (AP) in a teaching hospital as well as proffering possible reasons for such presentations which would serve as part of the solution to prevent such presentations in the future. BACKGROUND: Aggressive periodontitis is a severe form of destructive periodontitis traditionally believed to present around puberty. However, many cases seen in a teaching hospital presented much later for yet-to-be explained reasons. CASE DESCRIPTION: Seven patients referred to the specialist periodontal clinic of a Nigerian teaching hospital presented with clinical features consistent with AP. Most of the patients were over twenty and some over thirty years of age. CONCLUSION: Aggressive periodontitis patients seen in our center were often outside the traditional age brackets. The range of treatment options available to the patients were under-utilized due to serious financial constraints. CLINICAL SIGNIFICANCE: Aggressive periodontitis comes with serious psychological challenges and severe morbidity. Prompt diagnosis and effective management hold the key to success It is important to investigate why many of the cases seen in our center presented that late. Could be due to ignorance and poverty or could be due to failure of dentists recognize these cases and consequent misdiagnosis? Further studies are needed to answer these questions.

Subjective values of different treatments for missing molars in older Japanese.

The purpose of this study was to determine how elderly Japanese people subjectively value treatment options for missing molars. Subjects were 528 independently community-dwelling elderly people. They were presented with photographs and descriptions of the process and expected outcomes of five possible treatment options: cantilever fixed dental prosthesis (FDP); resin or metal removable partial denture prosthesis (RPDP); implant-supported fixed prosthesis; and no replacement (shortened dental arch: SDA) for missing lower bilateral first and second molars. The participants filled in the questionnaire on subjective importance for treatment and indicated on a visual analogue scale how they valued the treatment (utility value: UV). Values were analysed by Mann-Whitney U-tests and multiple logistic regression analyses. Overall, the UVs for the FDP and the metal RPDP were the highest, and the UV for the SDA was the lowest. With respect to subjective importance, 'chewing ability' and 'no pain during function' were significantly selected more frequently. Multiple logistic regression analyses showed that the UV for the resin RPDP had significant positive associations with denture wearers and low treatment cost, whereas the implant had significant negative associations with denture wearers and older age. The SDA had significant positive associations with men and low treatment cost and a negative association with appearance. In conclusion, these elderly Japanese preferred cantilever FDPs and metal RPDPs to implants and 'no replacement.' It suggests that the SDA as an oral health goal can be questionable from the patients' point of view, even if it is biologically correct.

Effort and costs of tooth preservation in supportive periodontal treatment in a German population.

OBJECTIVES: Assessment of effort (number of visits) and costs of tooth preservation 10 years after initiation of anti-infective therapy. MATERIAL AND METHODS: Data of 98 patients who had received active periodontal treatment 10 years ago by the same examiner were analysed to gather information on effort and costs of supportive periodontal therapy (SPT). Clinical examination, interleukin-1 (IL-1) polymorphism test, smoking, search of patients' files (i.e. initial diagnosis), as well as a questionnaire on medical history and socioeconomic data were performed. Statistical analysis was performed using multivariate linear regression analysis. RESULTS: During 10 years of SPT patients had 14.8+/-7.4 visits. Number of visits was statistically significantly higher for individuals with a mean plaque control record >or=24 %. The number of subgingival scalings per tooth ranged from 0 to 14 (mean: 1.17). On tooth level several confounders could be identified: tooth type, initial bone loss, furcation involvement, abutment status, and previous regenerative surgery (p

Patients' experiences with partial dentures: a qualitative study.

OBJECTIVE: The aim of the study was to gain insight into people's experiences of being given and using partial dentures. METHODS: In-depth semi-structured interviews were carried out with 23 people of varied age, social background and denture wearing experience in Tayside, Scotland. Participants were encouraged to discuss how they came to have partial dentures, their day-to-day denture use and their interactions with dentists. The interview data were systematically coded using key theme headings, and summary charts were constructed to facilitate analysis. RESULTS: The initial decision that a partial denture was needed was generally difficult to accept. People perceived the main benefits of partial dentures to be improved appearance and confidence, but experienced a variety of difficulties with their dentures and often coped with these by only wearing them on social occasions. Participants had not always told their dentists about the difficulties they experienced. Barriers to seeking help with denture problems included financial constraints, previous experience of rushed appointments or poor communication from dentists and a perceived lack of entitlement to help when partial dentures were issued free. CONCLUSIONS: Partial dentures can be difficult to cope with. People experience a range of difficulties in wearing them, not all of which have been discussed with dentists. Informative and supportive communication when partial dentures are first needed, and subsequently, can improve the quality of patients' experiences and may help promote effective use and appropriate help-seeking by partial denture wearers.

Denturists: do they really provide more affordable care in Ontario?

The 1996 Denturist Association of Ontario fee guide and the Ontario Dental Association Fee Guide for General Practitioners were examined to identify variations in the fees charged for a range of removable prosthodontic services. Fee guides were selected for this analysis as third-party insurers and government dental plans frequently use them to establish fee schedules and levels of reimbursement. However, it is recognized that dentists set their own fees, which may be higher or lower than the fees suggested in the guide. Although the descriptions of the specific services listed in the guides were similar in many cases, no attempt was made to examine variations in the quality of care provided by dentists and denturists, or the approach to treatment offered by their respective professions. The analysis revealed that a number of procedure fees were, on average, 15 per cent higher in the Ontario Dental Association (ODA) fee guide compared to the denturists' fee guide. However, a wide range of prosthetic services, including partial dentures, were less expensive in the ODA fee guide. Based on this analysis, there appears to be no substantial cost differential between the services provided by dentists and denturists six years after the proclamation of the new Regulated Health Professions Act in Ontario, as the denturists have claimed. The denturist association's further claims of greater choice and improved access may also be questionable, and should be reexamined in light of these findings.

Treatment times for posterior resin-bonded bridges.

In a longitudinal clinical trial the treatment times needed for the fabrication of Posterior Resin-Bonded Bridges (PRBB's) were recorded and analyzed. From a total of 200 PRBB's with different designs and retention systems, 152 were selected for this analysis. The selected bridges were made by 12 operators: 3 university staff members and 9 general practitioners. The mean treatment time for PRBB's was 80 min. When posterior composite restorations were made in the abutment teeth, the mean treatment time increased by 25% up to 100 min. From the factors which were considered to influence the treatment time, a significant effect was found for "restorations", "operator" and "experience of the operator". The other factors considered, such as "tooth preparation", "retention system", "isolation method", "occlusion", and "location", showed no detectable effect on the treatment time. The results of this study are considered to be useful in further cost-benefit analyses.