Oral health-related quality of life: acrylic versus flexible partial dentures.

BACKGROUND: Teeth lost are usually replaced by all-acrylic removable partial dentures (RPD) because of its affordability and ease of fabrication. The all-acrylic RPD is said to cause significant periodontal injury and consequently affect the oral health related quality of life (OHRQoL) of denture wearers. OBJECTIVE: To determine and compare OHRQoL of all-acrylic and flexible RPD wearers at baseline and after use of dentures. DESIGN AND SETTING: Study was quasi-experimental using a cross-over design, involving 30 patients with Kennedy class IV and anterior class III arches. Patient recruitment and review were done over an eight-month period in the Prosthetic Unit of a tertiary health facility. OHRQoL was assessed with the oral health impact profile-14 questionnaire. Data were analysed using descriptive and multivariate analysis at asignificant level of p <.05. RESULTS: Mean age of patients was 33.8 ±10.0 years; at baseline, patient reported occasionally, fairly often or very often for 11(78.6%) OHIP items. However, after using the acrylic and flexible partial dentures, 11(36.6%) patients reported having trouble pronouncing words and 9(30.0%) found it uncomfortable to eat respectively. At baseline, there was a difference in mean OHIP scores with age (p=.02); scores reduced from 12.4 ± 9.8 to 4.8±5.3 (CI= 3.3-12.0, p=.001) after using the all-acrylic denture and 3.8±5.6 (CI= 4.3-13.0, p<.001) with the flexible denture. CONCLUSION: There was improvement in the OHRQoL of patients with use of flexible partial dentures. Therefore, thermoplastic materials are possible alternative RPD base materials in patient management. FUNDING: None declared.

Oral health-related quality of life: acrylic versus flexible partial dentures

Background: Teeth lost are usually replaced by all-acrylic removable partial dentures (RPD) because of its affordability and ease of fabrication. The all-acrylic RPD is said to cause significant periodontal injury and consequently affect the oral health related quality of life (OHRQoL) of denture wearers. Objective: To determine and compare OHRQoL of all-acrylic and flexible RPD wearers at baseline and after use of dentures. Design and setting: Study was quasi-experimental using a cross-over design, involving 30 patients with Kennedy class IV and anterior class III arches. Patient recruitment and review were done over an eight-month period in the Prosthetic Unit of a tertiary health facility. OHRQoL was assessed with the oral health impact profile-14 questionnaire. Data were analysed using descriptive and multivariate analysis at asignificant level of p <.05. Results: Mean age of patients was 33.8 ±10.0 years; at baseline, patient reported occasionally, fairly often or very often for 11(78.6%) OHIP items. However, after using the acrylic and flexible partial dentures, 11(36.6%) patients reported having trouble pronouncing words and 9(30.0%) found it uncomfortable to eat respectively. At baseline, there was a difference in mean OHIP scores with age (p=.02); scores reduced from 12.4 ± 9.8 to 4.8±5.3 (CI= 3.3­ 12.0, p=.001) after using the all-acrylic denture and 3.8±5.6 (CI= 4.3­13.0, p<.001) with the flexible denture. Conclusion: There was improvement in the OHRQoL of patients with use of flexible partial dentures. Therefore, thermoplastic materials are possible alternative RPD base materials in patient management

Effect of resilient lining of obturator bulbs on patients with maxillectomies.

STATEMENT OF PROBLEM: Poly(methyl methacrylate) (PMMA) obturator bulbs are hard and nonresilient. The relief for these obturators limits the support available for the bulbs and may limit mastication on the side with the resection. Resilient liners may improve mastication by gaining greater support from closer contact with tissues within the defects. PURPOSE: The purpose of this crossover clinical trial was to compare masticatory function scores of individuals with maxillectomies rehabilitated by using all-PMMA and PMMA obturator bulbs lined with resilient silicone. MATERIAL AND METHODS: Twelve participants with maxillectomies were provided with 2 definitive obturator dentures after initial rehabilitation. One of the obturator dentures had a hollow obturator bulb in all-PMMA, while the other had a hollow-core PMMA with an outer layer of silicone-resilient liner. Participants wore each obturator for a 2-week period without washout. Masticatory function on the rehabilitated sides was assessed by using an adapted Sato questionnaire. Statistical analysis was performed by using paired t test results of mean masticatory function scores (α=.05). RESULTS: Participants found 98.35% of the foodstuffs easy to masticate on the dentate sides. An average of 60.40% of the participants found the foodstuffs easy to masticate on the rehabilitated sides with the silicone-lined obturators. 18.35% of participants found the foodstuffs easy to masticate with the all-PMMA obturators (P<.05). CONCLUSIONS: Resilient lining of PMMA resin obturator bulbs significantly improved masticatory ability in rehabilitated areas of the mouth.

Prevalence of additional canals in maxillary first molars in a Nigerian population.

AIM: The aim of this study was to investigate the prevalence of additional canals in maxillary first molars in a selected population in Nigeria. METHODS AND MATERIALS: One hundred extracted teeth were collected from the Pedodontic and Oral Surgery clinics of the University College Hospital in Ibadan, Nigeria. The teeth were identified and their root planed to remove adherent soft tissues. Each tooth was sectioned at the cementoenamel junction (CEJ) and then again at 2 mm below the CEJ. The number of canals present in each root was noted. For the clinical aspect of the study, 30 patients with clinical and radiological evidence of pulpal involvement participated in the study. These patients had root canal therapy performed on their maxillary first molars and the number of canals was confirmed with periapical radiographs. RESULTS: In the laboratory phase of the study 77% of the teeth sectioned had three canals while 22% had four canals with the fourth canal being a second mesiobuccal canal. Only one tooth had five canals with two canals in the palatal root, two canals in the mesiobuccal root, and the remaining canal in the distobuccal root. For the clinical phase of the study, 29 (96.7%) out of 30 patients treated had three canals while only one (3.3%) had four canals with the fourth canal being a second mesiobuccal canal. CONCLUSION: Clinicians should assume there are additional canals in each root when performing endodontic therapy on the maxillary first molar. Only after a thorough search for extra canals and after it is determined further preparation would be fruitless or could cause perforation should the clinician proceed with treating only one canal per root. CLINICAL SIGNIFICANCE: If root canal therapy fails, it may be due to the existence of an extra canal that was not located and treated in the first place. This should be considered carefully during re-treatment either by surgical or non-surgical methods.

Short-term clinical evaluation of four desensitizing agents.

AIM: To evaluate the effectiveness of four topical desensitizing agents in providing short-term relief of dentin hypersensitivity. METHODS AND MATERIALS: One hundred sixteen hypersensitive teeth with a positive response to intraoral testing for dentin hypersensitivity were included in this study. The four desensitizing agents tested were Duraphat, 2% fluoride iontophoresis, copal varnish (CV), and Gluma Comfort Bond Plus Desensitizer. Following a specific regimen randomly determined desensitizing agents were applied in an alternating order when patients presented in a clinical setting with a complaint of hypersensitive teeth. A visual analogue scale was used to determine the degrees of hypersensitivity at three points in time. The first being just before the treatment to establish a baseline, then at 24 hours post-treatment, and the last at seven days post-treatment. Differences in the mean pain scores (MPS) between the baseline and post-treatment evaluation periods were used to determine the reduction in dentin hypersensitivity. RESULTS: At baseline the MPS for teeth treated with CV was 5.34 (SD: 2.39), Duraphat was 4.66 (SD: 1.82), Gluma was 6.03 (SD: 2.37), and iontophoresis was 5.76 (SD: 1.37). At 24 hours post-treatment the MPS for CV was 2.1 (SD: 0.95), Duraphat was 1.38 (SD;1.86), Gluma was 0.79 (SD;1.45), and iontophoresis was 1.62 (SD1.97). The reduction in dentin hypersensitivity at 24 hours (difference between baseline MPS and 24 hour MPS) was 5.28 for Gluma, 4.14 for iontophoresis, 3.28 for Duraphat, and 3.24 for CV which were all statistically significant (p<0.05). At seven days, the MPS for CV was 1.55 (SD: 1.44), Duraphat was 1.0 (SD;1.89), Gluma was 0.10 (SD;0.44), and iontophoresis was 0.3 (SD;0.98). Reduction of hypersensitivity between 24 hours and one week was 1.32 for iontophoresis, 0.69 for Gluma, 0.55 for CV, and 0.38 for Duraphat. Only the reductions for iontophoresis and Gluma were statistically significant at seven days (p<0.05). CONCLUSIONS: All agents caused a statistically significant reduction in dentin hypersensitivity within 24 hours of treatment. Gluma performed best at 24 hours while iontophoresis appeared to have an edge at seven days. Long-term studies are needed to determine why this difference exists. Dentin hypersensitivity presents as an emergency condition requiring an effective means of providing immediate relief in the clinician's treatment armamentarium.

The prevalence of dentine hypersensitivity among adult patients attending a Nigerian teaching hospital.

PURPOSE: The purpose of this study was to determine the prevalence of dentine hypersensitivity and to examine some associated factors such as initiating stimuli among adult patients attendingthe Dental Clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. MATERIALS AND METHODS: All consecutive adult patients that presented at the oral diagnosis unit over a period of 13 months, from March 2003 to March 2004, were included in the study. Relevant history, such as nature of the pain, initiating stimulus, frequency of episode, interference with eating, drinking and toothbrushing were taken. Evidence of tooth surface loss was noted. Dentine hypersensitivity was confirmed clinically by the use of air blast from the air-water jet and scratching suspected surfaces with a dental probe. RESULTS: Of the 2165 patients examined, 29 were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 1.34%. The commonest teeth affected were the molars and the commonest initiating factor was cold water. Occlusal surfaces were most affected, followed by cervical surfaces. A male predominance was observed. CONCLUSION: A lower prevalence figure was found in the present study in comparison to earlier reported studies. The prevalence of dentine hypersensitivity is slightly lower in females, with female to male ratio of 1 to 1.42. Dentine hypersensitivity resulted in more severe disturbance when drinking water than when eating or brushing.

Acceptability of maxillary major connectors in removable partial dentures.

BACKGROUND: The choice of connector lies between plate, a bar or a combination of bars, which may cross the palate in various positions. Many opinions have been expressed concerning the acceptability to the patients of the various forms of palatal connectors but there have been few investigations. OBJECTIVES: The aim of this study is to compare subjective patients' reactions to three maxillary major connectors: metal bar, metal plate, and acrylic connectors and to establish the most acceptable and the least acceptable maxillary major connectors. METHODS: Fifteen consecutive patients attending the prosthetic out-patient clinic of Dental Center, University College Hospital, Ibadan who had never worn dentures were recruited into the study. Three dentures each with a different maxillary major connector design were fabricated for each patient. A questionnaire was administered to ascertain their reactions to each of the three denture designs. RESULTS: Fourteen patients (93.3%) preferred the denture with metal palatal bar major connector whereas only one patient preferred the denture with acrylic plate major connector design. No patient preferred the palatal metal plate connector design. CONCLUSIONS: The metal bar major connector was the most acceptable maxillary major connector while acrylic resin plate was more acceptable than metal plate maxillary major connector. It also confirmed the influence of connector design on patient acceptance of removable partial denture.

Esophageal impacted dentures.

OBJECTIVES: This study aims to highlight the problems associated with impacted acrylic dentures and proffers advice to check them. PATIENTS AND METHODS: Retrospective review of all cases of impacted acrylic dentures over a 16-year period. RESULTS: Twenty-two adults had impacted esophageal acrylic dentures of which 16 (72.7%) and six (27.3%) were males and females, respectively (M:F ratio = 2.7:1) with age range 23-77 years. Fourteen patients (63.6%) had worn their dentures for more than 10 years without check-up, and 54.5% presented within 48 hours of impaction. The common symptoms in all the patients were difficulty with swallowing, throat pain and discomfort, followed by tenderness in the neck in 15 (68.2%). Dentures were extracted through esophagoscopy (17 cases) and cervical (three cases) esophagotomy, respectively. Observed complications included pulmonary edema in one and esophageal perforation in five patients. CONCLUSION: Endoscopic extraction of dentures carries a high risk of perforation. Extraction of an impacted denture via esophagoscopy can be undertaken under direct vision and in an ideal situation with judicious use of the Shears forceps. In the absence of these, the safest option is an esophagotomy. Proper treatment planning in the fabrication of dentures with incorporation of radiopaque materials in the dental resins and adequate postdenture delivery instructions are necessary as preventive measures.