Oral health-related quality of life in US adults with type 2 diabetes.

OBJECTIVES: The objective of this study was to analyze factors associated with oral health-related quality of life (OHRQoL) between type 2 diabetes mellitus (T2DM) and nondiabetic US adults. METHODS: The study sample included 2945 participants (aged ≥20) selected from National Health and Nutrition Examination Survey (NHANES) 2003-2004 that represented 130,689,262 million persons in a probability weighted sample. Oral health outcomes were measured by the NHANES version of Oral Health Impact Profile (OHIP) for OHRQoL and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Multiple logistic regression models used dichotomous outcome variables OHIP-ADD and OHIP-SC. The cut-off values for poor OHRQoL were heuristically defined as OHIP-ADD ≥6 and as OHIP-SC > 0. RESULTS: Poor OHRQoL was significantly (p < 0.0001) predicted by T2DM (ORSC-controlled  = 1.43, ORSC-uncontrolled  = 1.73), obesity (ORSC  = 1.24), untreated dental caries (ORSC  = 1.79), periodontal disease (ORADD  = 1.07), evaluated unmet denture need (ORSC  = 1.72), low income (ORADD  = 1.22), smoking (ORSC-former-smoker  = 1.04, ORSC-current-smoker  = 1.99), African-American (ORSC  = 1.19), and female (ORSC  = 1.66) in both logistic regression models. In contrast, protective factors significantly (p < 0.0001) associated with poor OHRQoL were private dental insurance (ORSC  = 0.81), college education (ORSC  = 0.85), and annual dental prophylaxis (ORSC  = 0.83), after adjustment for covariates. CONCLUSIONS: This study showed that private insurance coverage and annual prophylaxis are associated with better average OHRQoL among individuals with T2DM. Improved OHRQoL may be associated with glycaemia control, decreased BMI, and smoking cessation. The highest odds for poor OHRQoL were found among US adults with T2DM with uncontrolled HbA1c, untreated dental caries, and current smoking.

Dynamic mechanical thermal analysis of maxillofacial prosthetic elastomers: the effect of different disinfecting aging procedures.

In this study, dynamic mechanical thermal analysis was used to evaluate the changes that occurred in maxillofacial elastomers subjected to different disinfecting regimens. A commercial polydimethyl siloxane (PDMS) and an experimental chlorinated polyethylene (CPE) were treated with different disinfection procedures for a period that simulates 1 year of clinical service: microwave exposure (D1), hypochlorite solution (D2), neutral soap (D3), and a commercial disinfecting solution (D4). A fifth group was kept in dark storage as control. Dynamic mechanical thermal analysis tests operated in a fixed frequency (1 Hz) over a range of temperatures (-130°C to 20°C for PDMS, -60°C to 120°C for CPE). Loss modulus (G″), storage modulus (G'), and loss factor (tanδ) were recorded as a function of temperature. The obtained glass transition temperature (Tg) values were subjected to statistical analysis. Dynamic mechanical thermal analysis revealed changes in Tg values for both materials, which reflect the possible changes in their chemical and physical structure, after different disinfection procedures. The PDMS and CPE samples seem to have less dense structure maybe because of chain scission reaction that probably occurred during the disinfection procedures. According to statistical analysis, Tg values presented significant changes from the control samples among the different materials and disinfecting procedures. Microwave exposure and hypochlorite solution affect CPE significantly, whereas PDMS exhibited significant changes after being treated with a commercial antimicrobial agent, concerning changes that occurred in Tg. In all cases, Tg values were decreased compared with the untreated samples, which were stiffer, presenting higher Tg and G' values.

Tensile and microindentation properties of maxillofacial elastomers after different disinfecting procedures.

STATEMENT OF PROBLEM: Daily disinfection of maxillofacial prosthesis may reduce their service-life and lead to replacement. PURPOSE: The purpose of this study was to evaluate possible alterations in the mechanical behavior of two maxillofacial elastomers after application of four different disinfection procedures. MATERIAL AND METHODS: The materials tested were two maxillofacial elastomers, a commercially available polydimethylsiloxane (PDMS) and an experimental chlorinated polyethylene (CPE). Different disinfection procedures such as microwave exposure, hypochlorite solution, neutral soap and a commercially antimicrobial solution, were applied for a period which simulates one year of a real service life. Mechanical behavior was investigated through tensile and microindentation tests in various depths. Mathematical models were fitted to tensile curves. Alterations in tensile parameters (maximum stress, maximum strain, elasticity and viscoelasticity parameter) were subjected to two way ANOVA and Tukey's post hoc tests (α=.05). RESULTS: Most of the tensile parameters presented significant alterations among different disinfection procedures and maxillofacial materials which became also harder. Microwave exposure caused greater changes in PDMS and CPE elastomer whereas commercial antimicrobial solution and neutral soap did not significantly affect them. Microindentation and tensile tests revealed similar changes in materials' elastic modulus and hardness whereas the observed changes were greater into smaller depths. CONCLUSIONS: Tensile and microindentation properties of PDMS and CPE elastomers presented changes after disinfected with four different procedures. Changes in the surface of both materials were more intense than in the bulk of the materials. Microwave exposure affected most the two elastomers, so concerning the findings of this study is not recommended for the disinfection of the examined PDMS and CPE elastomers. Moreover, microwave exposure and hypochlorite solution caused greater changes in the surface (3µm) of CPE samples as indicated by microindentation results. PDMS affected less from the commercial antimicrobial agent and CPE from neutral soap, which seems to be the most suitable disinfection techniques.

Effect of different disinfecting procedures on the hardness and color stability of two maxillofacial elastomers over time.

OBJECTIVE: Disinfection procedures often cause deterioration in a maxillofacial prosthesis. Color and hardness alterations could lead to a replacement of the prosthesis. MATERIAL AND METHODS: An experimental chlorinated polyethylene (CPE) and a commercial polydimethyl siloxane (PDMS) sample were treated with four different disinfection procedures for a period which simulates 1 year of clinical service. The applied disinfection procedures included microwave exposure and immersion in three solutions, sodium hypochlorite, neutral soap and a commercial disinfecting soap. Shore A hardness (∆H) and color differences (∆E) were determined before and after each procedure. All data were analyzed by Two Way Analysis of Variance (ANOVA) and Tukey's post hoc tests at a level of α=0.05. RESULTS: The samples presented significant alterations in color and hardness after the different disinfection treatments. The color differences (∆E) were at least eye detectable in all cases and clinically unacceptable in most of the cases, with values ranging from 1.51 to 4.15 and from 1.54 to 5.92 for the PDMS and CPE material, respectively. Hardness was decreased after all the disinfection procedures in the PDMS, while for the CPE, a decrement was observed after disinfection with sodium hypochlorite and neutral soap and an increment after microwave exposure and the disinfection with a commercial antimicrobial agent. The PDMS samples presented greater alterations in color and hardness after disinfection with sodium hypochlorite solution, while the microwave exposure caused negligible effects. The CPE samples were affected most after disinfection when treated with neutral soap, and more slightly when disinfected with sodium hypochlorite solution. CONCLUSIONS: The disinfection procedures caused alterations in color and hardness of the examined materials. The most suitable disinfection procedure for the PDMS material is microwave exposure, while disinfection with sodium hypochlorite solution is not recommended. The CPE material is suggested to be disinfected with sodium hypochlorite solution and the use of neutral soap is not recommended. Comparing the two materials, the PDMS material is most color stable, while the CPE material presented fewer changes in hardness.

Effect of different disinfecting procedures on the hardness and color stability of two maxillofacial elastomers over time

Objective Disinfection procedures often cause deterioration in a maxillofacial prosthesis. Color and hardness alterations could lead to a replacement of the prosthesis. Material and Methods An experimental chlorinated polyethylene (CPE) and a commercial polydimethyl siloxane (PDMS) sample were treated with four different disinfection procedures for a period which simulates 1 year of clinical service. The applied disinfection procedures included microwave exposure and immersion in three solutions, sodium hypochlorite, neutral soap and a commercial disinfecting soap. Shore A hardness (∆H) and color differences (∆E) were determined before and after each procedure. All data were analyzed by Two Way Analysis of Variance (ANOVA) and Tukey's post hoc tests at a level of α=0.05. Results The samples presented significant alterations in color and hardness after the different disinfection treatments. The color differences (∆E) were at least eye detectable in all cases and clinically unacceptable in most of the cases, with values ranging from 1.51 to 4.15 and from 1.54 to 5.92 for the PDMS and CPE material, respectively. Hardness was decreased after all the disinfection procedures in the PDMS, while for the CPE, a decrement was observed after disinfection with sodium hypochlorite and neutral soap and an increment after microwave exposure and the disinfection with a commercial antimicrobial agent. The PDMS samples presented greater alterations in color and hardness after disinfection with sodium hypochlorite solution, while the microwave exposure caused negligible effects. The CPE samples were affected most after disinfection when treated with neutral soap, and more slightly when disinfected with sodium hypochlorite solution. Conclusions The disinfection procedures caused alterations in color and hardness of the examined materials. The most suitable disinfection procedure for ...

The Toronto outcome measure for craniofacial prosthetics: reliability and validity of a condition-specific quality-of-life instrument.

PURPOSE: The purpose of this study was to refine the Toronto Outcome Measure for Craniofacial Prosthetics (TOMCP), present evidence for its reliability and validity, and use the instrument to explore differences in quality of life between prostheses made with chlorinated polyethylene (CPE) (experimental) and silicone (control). MATERIALS AND METHODS: As part of a multicenter prospective controlled randomized double-blind single-crossover clinical trial of the two materials, the TOMCP was administered at the start and end of two 4-month study arms, during which 42 patients wore prostheses made from one material then the other. Reliability was assessed at the crossover. To determine validity of the TOMCP, the Linear Analogue Self-Assessment (LASA-12) and the Short-Form 8 (SF-8) were also administered with the TOMCP. The TOMCP was reduced by removing items that were unreliable, had poorly distributed answers, showed increased internal consistency after their removal, or were too highly correlated with more than one other item. The tests of reliability and validity were then repeated. Finally, the reduced instrument was used to test for differences in quality of life between prostheses made of the two materials. RESULTS: The item reduction tactics pared the 52-item instrument down to 27 items. The correlations of both TOMCP versions with the LASA-12 and the SF-8 were found to be statistically significant, providing evidence of the validity of the TOMCP. The instrument revealed significantly better quality of life with silicone rather than CPE prostheses. CONCLUSIONS: Both versions of the TOMCP were found to be reliable and valid. The instrument was able to show differences in quality of life between two materials.

Effects of outdoor weathering on facial prosthetic elastomers.

Physical weathering is usually responsible for the degradation of maxillofacial prosthetic elastomers and the replacement of prostheses. The purpose of this study was to investigate the effects of outdoor weathering on the physical properties of four nonpigmented facial prosthetics after 1 year of exposure. In addition, simple mathematical models were developed to correlate the measured properties with irradiation time, including parameters with physical meaning. Three different medical-grade polydimethyl siloxanes (PDMSs) and an experimental chlorinated polyethylene (CPE) were examined in this study. The samples were exposed to solar radiation for 1 year in Athens, Greece. Mechanical tests (compression and tensile) were performed using universal-type testing machine, and hardness measurements were performed with a durometer (Shore A). Thermal tests were also performed with a differential scanning calorimeter. Simple mathematical models were developed to describe the examined properties. Changes observed in the properties of examined materials, before and after the exposure, reflected the effect of weathering. More specifically, two of the silicone prosthetics (Elastomer 42, TechSIL 25) seemed to become harder and more brittle, different from the other silicone (M511) sample and the CPE sample, which became softer and more ductile. Moreover mathematical models correlate the measured properties with irradiation time, and their constants indicate that duration of exposure seems to increase the degradation. Significant changes in the mechanical and thermal properties of the examined materials were observed as a result of outdoor weathering. The effect of weathering on samples' properties was introduced through its effect on the mathematical models' parameters.

Clinical trial of chlorinated polyethylene for facial prosthetics.

PURPOSE: Extraoral maxillofacial prostheses have been fabricated with silicone elastomer for 50 years with few improvements. The objective of this controlled, randomized, prospective, double-blind, single-crossover, multicenter, phase III clinical trial was to determine the noninferiority of chlorinated polyethylene elastomer (CPE) to silicone elastomer for fabricating prostheses. MATERIALS AND METHODS: Forty-two patients were randomly assigned to wear a custom-made prosthesis fabricated from both materials for 4 months and asked to rate their satisfaction (0 = not satisfied, 10 = completely satisfied). Many other measures of prosthesis performance were investigated (see online appendices). RESULTS: Of the 28 patients who completed the study, 68% had used silicone prostheses previously. Overall, patients rated the silicone prosthesis higher than CPE (difference: 2.2, 95% confidence interval [CI]: 0.9 to 3.6, P = .017). Previous users had a stronger preference for silicone (difference: 3.3, 95% CI: 1.7 to 4.9, P = .001), while the 9 new users rated the two materials similarly (difference: 0.0, 95% CI: -2.1 to 2.1, P = 1.00). CONCLUSIONS: The noninferiority of CPE could not be established because of the early termination of the trial. Previous users of silicone prostheses preferred those made of silicone. However, new users expressed no preference between prostheses fabricated with the low-cost CPE or silicone. The authors have developed original clinical trial methodology for assessing extraoral maxillofacial prostheses.

Material properties of a maxillofacial chlorinated polyethylene elastomer stored in simulated skin secretions.

STATEMENT OF PROBLEM: Facial prostheses deteriorate in a service environment primary due to exposition to various environmental factors, including sebaceous oils (sebum) and perspiration. PURPOSE: This study investigated the physical properties of an experimental, facial prosthetic after immersion for 6 months in simulated sebum, and perspiration at 37 degrees C. MATERIAL AND METHODS: Chlorinated polyethylene (CPE) specimens were immersed in simulated perspiration as well as in sebum. Compression tests were conducted on a Zwick testing machine. Shore A hardness measurements were carried out in a CV digital Shore A durometer. Melting and glass transition temperatures were evaluated with a differential scanning calorimeter. Weight changes were measured and color changes were determined in the CIE LAB system using a MiniScan XE spectrophotometer. Simple mathematical models were developed to correlate the measured properties with immersion time. The data were also subjected to analyses of variance (ANOVA) and the Tukey multiple range tests at a level of alpha = 0.05. RESULTS: Specimens immersed in perspiration became harder due to facilitation of the propagation of cross-linking reaction that probably occurred during aging of the CPE samples. Some weight increase was observed for the specimens immersed into the aqueous solutions, whereas for those immersed in sebum, weight loss was recorded, probably because of extraction of some compounds. The color change was higher for the specimens immersed in sebum than that corresponding to simulated perspiration. CONCLUSIONS: The chlorinated polyethylene specimens aged for a period, which simulates 1.5 years of clinical service1, showed significant deformations in their physical properties.

Simulated microbe removal around finger rings using different hand sanitation methods.

AIM: It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only "recommend" removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes. METHODOLOGY: A gloved rubber hand manikin was made and fitted with a fresh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20 degrees C and 40 degrees C water alone, or with liquid hand soap. Light levels (in lux) of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance (ANOVA) was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey's post hoc honestly significant difference (HSD) test was applied to significant factors to examine pair-wise differences between factor levels. RESULTS: It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings. CONCLUSION: The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.

Adhesive retention of silicone and chlorinated polyethylene for maxillofacial prostheses.

STATEMENT OF PROBLEM: A key factor of a successful facial prosthesis is the retention of the prosthesis to the patient's skin, especially when there is no mechanical means and the retention depends primarily on medical skin adhesives. Studies determining which medical adhesives provide the best bond strength for maxillofacial prostheses are needed. PURPOSE: The purpose of this study was to quantify the force required to detach strips of Silastic Adhesive A/MDX4-4,210 silicone elastomer with a urethane liner (A/M-U) and experimental chlorinated polyethylene elastomer (CPE) from the skin of human subjects coated with a protective dressing using 1 of 2 medical adhesives. MATERIAL AND METHODS: With IRB approval, 8 A/M-U and CPE rubber strips (total of 208) were applied in a predetermined random order to the left and right ventral forearms of 26 human subjects. Skin-Prep Protective Dressing (SP) was applied to half of the sites just before Epithane-3 (E3) and Secure(2) Medical Adhesive (SMA) were used to adhere the strips. Strips were peeled 6 hours later in a universal testing machine at 10 cm/min. Data are reported in newton/meter (N/m). The data was compared using a 3-way, within-groups, multivariate analysis of variance (MANOVA) and the Fisher exact test (alpha=.05). Values for N/m under various conditions relating to the subjects were compared by the Tukey HSD Test for unequal N (alpha=.05). Data are reported as mean (SD). RESULTS: Statistical analysis revealed no differences (mean (SD)) and no significant interactions between the independent variables (A/M-U = 94.6 (62.1) and CPE = 98.4 (69.6) N/m, SP = 93.0 (58.8) and no SP = 99.8 (72.1) N/m, E3 = 97.6 (69.8) and SMA = 95.3 (61.8) N/m; P=.984). Debonding occurred at the skin interface for both adhesives, as evidenced by residue on prosthetic materials (Fisher exact test; P<.005). CONCLUSIONS: The adhesive bond strengths of both SMA and E3, with and without the presence of SP, were not significantly different between A/M-U and CPE maxillofacial prosthetic materials. Adhesive failure occurred at the skin interface.

Facial prosthetic rehabilitation: preprosthetic surgical techniques and biomaterials.

PURPOSE OF REVIEW: Attention to detail ensuring a successful facial prosthetic rehabilitation must be considered a priority at the time of presurgery, surgery, and at every stage in fabricating the prosthesis. Teamwork between the surgeon and maxillofacial prosthodontist will ensure an optimal surgical preparation and definitive prosthesis. RECENT FINDINGS: Evidence of interaction between team members can most certainly be encouraging to the patient. During the prosthetic phase of treatment, focusing on tissue assessment, impression making, sculpting, mold fabrication, familiarity with materials, appreciation of color, delivery of instructions, and patient education will ensure a satisfactory outcome. With the desire, determination, and encouragement from the restorative team to make the most of this artificial replacement, a patient can have a higher quality of life and a more normalized lifestyle. SUMMARY: This review presents current concepts regarding facial prosthetic rehabilitation of patients with head and neck cancer and facial prosthetic biomaterials.

The influence of water storage on durometer hardness of 5 soft denture liners over time.

PURPOSE: This laboratory study investigated the influence of water storage on the durometer hardness of 2 RTV and 3 HTV soft denture liners over a 1-year period. MATERIALS AND METHODS: Five soft denture liners were used: 2 HTV silicone rubber (Luci-Sof and Molloplast-B), 1 RTV silicone rubber (Tokuyama), 1 HTV polyphosphazene (Novus), and an RTV plasticized acrylic (PermaSoft) that uses a surface sealer. They were processed following manufacturers' instructions, cured, and stored in tap water at 37 degrees C. The water was changed every 2 weeks. Five durometer A hardness measurements were made at logarithmically spaced intervals of 16.7 minutes, 27.8 hours, 11.6 days, 34.7 days, 115 days, and 347 days. Repeated measures analysis of variance (MANOVA), one-way analysis of variance (ANOVA), Pillai trace statistic, the difference scores (last-first) among the groups, and the Tamhane T2 multiple comparison test were used to compare the groups over time, all on SPSS V. 7.5 and 9.0. RESULTS: The order of highest initial indentation hardness was Luci-Sof, Molloplast-B, Novus (H(D)= 38 to 33). Tokuyama and PermaSoft as a group were softer (H(D)= 18 to 22). Tokuyama Soft Relining changed the least over 347 days, followed by Luci-Sof, Novus, Molloplast-B, and PermaSoft in that order (p < or = 0.05). Within the PermaSoft group, sealer applied only once changed the least over 347 days, followed by no sealer, and then sealer applied every month (p < 0.0005). CONCLUSIONS: After 347 days of water storage, Tokuyama had the lowest indentation hardness changes, followed by Luci-Sof, Novus, PermaSoft with sealer applied once; Molloplast-B, PermaSoft without sealer; and PermaSoft with sealer applied every month. All HTV soft denture liners had higher indentation hardness than RTV liners initially. After 347 days, PermaSoft without sealer and with sealer every month became the hardest.

Effect of multi-adhesive layering on retention of extraoral maxillofacial silicone prostheses in vivo.

STATEMENT OF PROBLEM: Loss of retention of maxillofacial prostheses often makes the margin visible or the prosthesis dislodge. Using several medical adhesives in combination may improve retention. PURPOSE: The purpose of this study was to investigate the effect of single- and multi-adhesive layering of 2 adhesives on the retention of maxillofacial silicone elastomer strips adhered to the skin of human forearms using a peel test. MATERIAL AND METHODS: Power analysis from a previous study and a pilot trial specified at least 20 subjects. Eight Silastic Adhesive A/MDX4-4210 silicone rubber strips (N=240) were applied in a predetermined random order to the left and right ventral forearms of 30 IRB-approved human subjects. Skin-Prep Protective Dressing was applied. Secure 2 Medical Adhesive (SMA) and Epithane-3 (E3) adhesive were used alone or as SMA/E3 or E3/SMA sandwiches (from skin to prosthesis) to adhere strips. Strips were peeled 6 hours later in a universal testing machine at 10 cm/min and data reported in N/m. Paired t tests were used to evaluate left and right arm differences. A Friedman test for nonparametric correlated data with within-subject design was performed, determining differences between both adhesives singly and in combination (alpha=.05). RESULTS: Tests of left-right differences were insignificant ( P =0.43), so the data from both arms were combined. Many strips with E3 did not adhere before testing and were counted as 0 adhesion. Median peel strengths (and 25th and 75th percentiles) in N/m were: SMA = 76.1 (47.1-107), E3 = 6.75 (0.0-25.9), SMA/E3 = 107 (78.0-132), and E3/SMA= 19.6 (6.99-42.4). All 4 variables were significantly different ( P <.0005). CONCLUSION: The multi-adhesive combination of SMA/E3 had the highest adhesion, followed, in order, by SMA alone, E3/ SMA, and E3 alone. Both E3 groups left a difficult-to-remove residue on the skin. SMA/E3 left a halo-like residue on the skin at the periphery of the strips from the E3 leaking around the SMA. SMA remained adherent to the prosthetic material.

Use of primates for wear testing of dental restorative materials.

The mechanical loss of substance, both of teeth and man-made materials used to fill or replace teeth, principally occurs by attrition (the grinding of one tooth against another) or abrasion due to coarse particles present in the diet, dentifrices, or as products of the grinding itself. Nonhuman primates often have pronounced grinding or bruxing habits that serve to sharpen the teeth. Papio anubis baboons were used as a model to study the ability of teeth and restorative materials to withstand continual two- or three-body wear. One test site used the mandibular first premolars, occluding with the maxillary canines. For other studies, fixed appliances were cemented to the upper and lower incisors allowing placement of materials. Periodically, replica models of the surfaces were made for examination in a scanning electron microscope. Detailed descriptions of the morphological changes and/or failure of the materials appear elsewhere. It was found that the nonhuman primate model provides a rapid test of physiologic and pathologic wear of dental materials. It differs from the human situation only in the lack of good oral hygiene and the absence of extremes of thermal variations.