Ece Eden

Managing dental caries in children in Turkey - a discussion paper

BackgroundThis paper describes the oral healthcare system and disease situation amongst children in Turkey. Considering the high prevalence and severity of dental caries, a proposal for improvement of oral health in this population group is formulated.DiscussionA virtual absence of palliative, preventive and restorative care characterises juvenile oral healthcare in Turkey. Consequently, carious cavities remain untreated, which may lead to pain, discomfort and functional limitation and, further, may impact negatively upon general health and cognitive development. As a first step to controlling dental caries, a national health programme including promotional, preventive and minimal intervention approaches for managing dental caries is proposed. The pros and cons of community-oriented caries-preventive measures are discussed. Daily tooth brushing with fluoridated toothpaste at home, in mother- and child-care centres, kindergartens, and schools is highlighted.SummaryThe dental profession, government, university officials and other stakeholders need to meet and determine how best the oral health of children in Turkey can be improved. The present proposed plan is considered a starting point.

Multidiciplinary treatment of complicated subgingivally fractured permanent central incisors: two case reports

Subgingival crown fractures with pulp exposure in permanent teeth present both endodontic and restorative problems with unfavorable prognosis. Numerous restorative techniques such as resin composite restorations with and without pins, crowns and reattachment of the fractured dental fragment could be listed as the treatment options. There are several successful cases in the literature where advantages of less microleakage and proper gingival biocompatibility in cases with reattachment of the tooth fragment were reported. Two cases of palatinal subgingival crown fractures are reported. Both had been restored by reattachment of the fragment and composite with the help of the flap surgery. Follow up visits (Case 1 for 4 years and Case 2 for 1 year) revealed satisfactory esthetics and function.

Shear bond strength of restorations applied to un-complicated crown fractures: an in vitro study.

BACKGROUND Study was designed to evaluate shear bond strengths of different restorative techniques of uncomplicated enamel-dentin fractures in permanent incisors. MATERIAL AND METHODS Forty human mandibular incisors were divided into four groups. One-third of their anatomical crowns from the incisal edges were cut off in three groups, representing an uncomplicated enamel-dentin fracture. Intact teeth in group 1 were used as control. In group 2, edge fragments were reattached by flowable composite (Filltek Flowable Supreme XT). In group 3, teeth were restored with universal resin composite (Filtek Z 250). In group 4, pre-impregnated glass fiber sheet (everStickNet) was positioned onto fractured surface, and then restorations were completed with resin composite. Three-step etch-and-rinse adhesive system (Adper Scotchbond Multi Purpose) was used in all test groups. Shear bond strengths of all samples were determined in universal testing machine, and data were analyzed with Kruskal-Wallis followed by Mann-Whitney U tests. Failure types were observed by light microscope. RESULTS Shear bond strength of sound teeth was significantly higher than those of restored teeth (P < 0.05). Mean shear bond strengths of the reattached teeth were lower than the other two restoration types; however, differences were not statistically significant (P > 0.05). CONCLUSIONS Load-bearing capacity of restored teeth was not as high as sound teeth in the uncomplicated crown fracture. However, shear bond strength of different types of restorations seems close to each other.

Biocompatibility of glass ionomer cements with and without chlorhexidine.

Objective: The aim of the present study is to evaluate the biocompatibility of glass ionomer cements (GICs) with and without chlorhexidine (CHX) as well as coated with varnish or not using in vitro cytotoxicity test. Materials and Methods: Biocompatibility of Fuji IX, Fuji IX with varnish, Fuji IX with 1% CHX diacetate and Fuji IX with 1% CHX diacetate with varnish was determined with in vitro cytotoxicity assay by using L929 mouse connective tissue fibroblasts. After 72 h, cell viabilities were evaluated by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay to determine the effects of the cements on the mitochondrial function and microscopic images were taken by scanning electron microscopy. Results: Statistical analysis was performed by one-way analysis of variance followed by the Bonferroni post-hoc test at a significance level of P < 0.05. 72 h after treatment, there were statistically significant differences between Fuji IX and Fuji IX-CHX (P < 0.001). In addition, the reduction of the cytotoxicity by coating the GICs with varnish was indicative and increased the cell viability ratio (P < 0.001). Conclusions: Fuji IX coated with varnish was found to be the most biocompatible one among others. Thus adding CHX significantly reduced the cell viability, it is assumed that, due to the leakage of CHX and the other components of the GICs to the cell culture medium, the cell viabilities were decreased, so it is highly recommended to use varnish not only to reduce the water loss from the GICs, but also to reduce the cytotoxicity of the GICs.

Antibacterial efficacy of prophylactic ozone treatment on patients with fixed orthodontic appliances.

Abstract Objective. This study investigated the efficacy of ozone on microflora of patients with fixed orthodontic appliances. Materials and methods. Ten subjects undergoing fixed appliance therapy were enrolled in the study. Before any application, two elastic ligatures were removed with the aid of a sterile probe from the premolar brackets on the upper right and lower left jaws for baseline bacteriological counts. Then ozone gas was applied for 180 s by running the device on prophylaxis mode with included mouth tray according to the manufacturers recommendations on all brackets. After the ozone application, two other elastic ligatures were removed from the opposite sides of the mouth of the patients. One week after the application two more elastic samples, which were not changed in the previous session, were collected from the upper right and lower left premolar brackets. The elastic ligatures were immersed in transfer solutions and cultured to determine the Streptococcus mutans and Lactobacillus acidophilus. Statistical analysis of the data was obtained by paired Students t-tests. Results. The ozone treatment reduced the S. mutans and L. acidophilus immediately after the application and these reductions were found to be statistically significant (p = 0.038 and p = 0.020). Both the S. mutans and L. acidophilus values increased by the 1-week period and the S. mutans values were significantly higher than the baseline values (p = 0.01). Conclusion. It can be concluded that the ozone treatment may have an instantaneous lethal effect on S. mutans and L. acidophilus; however, within the limitations of this study, a long-term preventive effect could not be observed.

Treatment of sequelae in permanent dentition after severe trauma in primary dentition

A case with a dilacerated upper right central and hypoplastic upper right lateral incisors covered with gingiva of a 10-year-old female, with a history of trauma at the age of 18 months, is presented. After clinical and radiographical evaluations, esthetic problem was solved with gingivectomy followed by composite restorations of the involved teeth.

Caries in primary molars of 6–7-year-old Turkish children as risk indicators for future caries development in permanent molars

Background/purpose The aim of the present study was to investigate whether caries existence in the primary dentition at the age of 6-7 years can serve as a test to predict subsequent caries in the permanent first molars. Clinical examinations were carried out in suboptimal conditions of a school-based screening, where non-cavitated enamel caries could not be recorded. Materials and methods Caries were recorded at baseline and 4 years later in 286 Turkish children aged 6-7 years old. Spearmans correlation coefficients between variables of the caries experience of the primary dentition at the age of 6-7 years and caries in the permanent first molars at the age of 10-11 years were calculated. The area under the ROC curve was used as a measure of predictive accuracy. Results Caries experience of the primary dentition (dmft), primary molars (dmft molars), and primary second molars (dmft 2nd molars) showed a statistically significant correlation with caries (DMFT) 4 years later in the permanent first molars. Among the variables, the caries experience of the primary second molars was the most powerful caries predictor, which resulted in a value of 0.69 under the ROC curve. Conclusion With the selection criterion “dmft2ndmolars = 0” in this low-caries-incidence pediatric population, it was possible to identify children truly negative for misclassification.

Antimicrobials in Caries Prevention

Regularly removing biofilm and controlling risk factors are essential to the individual and the clinician for managing dental caries. As an alternative way of preventing and managing the disease, researchers have developed and investigated antimicrobial agents to counter the bacterial component in the caries process. However, these agents are considered to have limited value and are therefore restricted to special care groups. This chapter summarises the effect of antimicrobial agents such as chlorhexidine, iodine and ozone as well as the antimicrobial effect of natural products on managing carious lesion development.

Caries Management and Prevention in Relation to the Needs of the Patient

This chapter will present sample cases from different life phases starting from pregnancy to senescence, as well as various complicated conditions such as systemic disorders or cancer treatment, where various regimes of prevention are suggested and discussed.

Restoring crown fractures by direct composite layering using transparent strip crowns.

Traumatic dental injuries are mostly seen at childhood and adolescence. The most common fracture in permanent anterior teeth is crown fracture. Esthetic and easy rehabilitation of these anterior teeth is possible using layering techniques and direct composite resin restorations. Shape, color and surface texture are the most important factors in restoring crown fractures esthetically. This article illustrates how to perform an esthetic composite resin restoration of crown fractures using strip crowns. The technique suggests using a strip crown as a mold for direct resin composite restoration. This provides a cost-effective treatment with operator friendly approach where most outstanding advantage is the minimum chair-side time with a single visit that is very important for young trauma patients.