Gert-Jan Truin

Prevalence of Caries and Lesions Treatable through the ART Approach in High Caries Risk Schoolchildren in Damascus, Syria

Objective: To determine the prevalence of dentinal lesions treatable through the atraumatic restorative treatment (ART) approach for high caries risk schoolchildren. Subjects and Methods: A convenience sample was taken of 1,542 grade 1 and 931 grade 2 children from 21 primary schools in a low socio-economic area in Damascus. Dentinal lesions in which the smallest excavator (diameter of 0.9 mm) could enter the cavitated lesion were considered treatable using the ART approach. Mann-Whitney U and ANOVA tests were used to analyse the data. Results: The mean dmfs and dmft scores of the 6- to 7-year-olds (grade 1) were 9.0 and 4.4, respectively. The mean DMFS and DMFT scores of the 7- to 8-year-olds (grade 2) were 1.6 and 1.4, respectively. At least 89.9 and 54.9% of the dentinal lesions in the deciduous and permanent dentition that were in need of a restoration, respectively, were diagnosed as treatable using ART. Conclusion: A high proportion of dentinal lesions in need of restorations in both deciduous and permanent dentitions in this high caries risk group of 6- to 8-year-olds were diagnosed as being treatable using the ART approach.

Determining the Explanatory Potential of Variables

A meta-analysis may not be the most appropriate method for the extraction of information on independent variables from the scientific literature. A formal quantitative review method is proposed for reducing a literature review variable list to a manageable list of explanatory variables. The proposed method synthesizes the information in a standard literature review into two steps. First, the hypothesis “independent variable ‘X’ had no effect on utilization” is tested by means of binomial, one-sided testing. If it is rejected, then the hypothesis “The effect of independent variable ‘X’ is as likely to be in the same direction as it is to be in the opposite direction” is tested, by an extended version of the binomial formula. In two steps, the presence of a consistent direction of significant effects is calculated. This method is tested on dental utilization publications. It is concluded that the method is an effective tool for the creation of a manageable variable list.

Temporomandibular Disorders: “Occlusion” Matters!

By analogy with the journals title Pain Research and Management, this review describes TMD Research and Management. More specific are the (1) research aspects of “occlusion,” still one of the most controversial topics in TMD, and (2) as much as possible evidence-based management aspects of “TMD” for the dental practitioner. Research. The disorders temporomandibular dysfunction and the synonymous craniomandibular dysfunction are still being discussed intensely in the literature. Traditionally, attention is mostly devoted to occlusion and its relationship with these disorders. The conclusions reached are often contradictory. Considering the definitions of temporomandibular and craniomandibular dysfunctions/disorders and “occlusion,” a possible explanation for this controversy can be found in the subsequent methodological problems of the studies. Based on a Medline search of these terms over the past 40 years related to contemporary terms such as “Evidence Based Dentistry” and “Pyramid of Evidence,” these methodological aspects are examined, resulting in recommendations for future research and TMD-occlusal therapy. Management. To assist the dental practitioner in his/her daily routine to meet the modern standards of best practice, 7 guidelines are formulated that are explained and accompanied with clinical examples for an evidence-based treatment of patients with this disorder in general dental practices.

Mimicking and Measuring Occlusal Erosive Tooth Wear with the "Rub&Roll" and Non-contact Profilometry

Chewing, drinking, and occasional tooth grinding will result in physiological tooth wear during a lifetime. Extreme challenges, such as bruxism or habitual chewing on foreign objects, may lead to excessive wear. Recently, the role of erosion in accelerating mechanical tooth wear has been recognized, but the interplay between chemical and mechanical wear processes has not been extensively studied. Our laboratory recently introduced a novel oral wear simulation device, the Rub&Roll, that enables the user to perform wear and loading studies separately or simultaneously in an erosive and/or abrasive environment. This manuscript describes an application of the device: the combined mechanical and erosive loading of extracted human (pre)molars in a simulated chewing movement, with a controlled application of force, velocity, fluid, and time, and the application of non-contact profilometry in visualizing and measuring the resulting wear pattern. The occlusal morphology that was created in the experiment with the highest loading level is very similar to the clinical presentation of erosive wear.

A new in situ model to study erosive enamel wear, a clinical pilot study

OBJECTIVES To develop an in situ model for erosive wear research which allows for more clinically relevant exposure parameters than other in situ models and to show tooth site-specific erosive wear effect of an acid challenge of orange juice on enamel. METHODS This pilot study included 6 edentulous volunteers wearing full dentures with 13 embedded enamel samples The study consisted of two control runs: habitual diet only for 30days, and two experimental runs: habitual diet plus 125ml orange juice four times per day (consumed over 4m). In the first experimental run subjects were instructed to take the drink in their mouth and promptly swallow it. In the second experimental run subjects take the drink in their mouth and hold each 25ml for 30s, moving it around their mouth before swallowing. Sample enamel surface loss was measured using non-contact surface profilometry. RESULTS Drinking of orange juice additional to the habitual diet, caused significant but low increased erosive wear at buccal, palatal and lingual specimens. Significantly higher levels of tissue loss were found on all surfaces in the swishing experiment but molars (especially occlusal specimens in mandibular molars), palatal specimens sited in upper anterior teeth and lingual specimens in lower anterior teeth were most affected. CONCLUSION The model showed clinically relevant patterns of erosive tooth wear as seen clinically in erosive wear patients. CLINICAL SIGNIFICANCE The model could have many applications to study clinically erosive wear for specific diets or consumption patterns and to test preventive measures.