Jay D. Shulman

A scanning electron microscopic evaluation of root canal debridement using saline, sodium hypochlorite, and citric acid***

This study used a scanning electron microscope and a rank-ordered scoring system to evaluate statistically the amount of superficial debris and the smeared layer that remained on the canal wall following root canal preparation with six different debridement regimens. Regimens which used citric acid or a combination of NaOCl and citric acid for irrigation were more effective than NaOCl alone in removing the smeared layer from the surface of the prepared root canal walls.

Comparative Assessment of ActiV GP/Glass Ionomer Sealer, Resilon/Epiphany, and Gutta-Percha/AH Plus Obturation: A Bacterial Leakage Study

The objective of this study was to compare the sealing ability of ActiV GP/glass ionomer (GI) sealer (Brasseler USA, Savannah, GA), Resilon/Epiphany (Pentron Clinical Technologies, Wallingford, CT), and gutta-percha (GP)/AH Plus (Dentsply Maillefer, Tulsa, OK). Seventy-three human single-rooted teeth were randomly divided into three test groups (20 canals each) and two control groups (5 positive and 8 negative). Using Enterococcus faecalis, a split-chamber bacterial leakage model was developed to evaluate the sealing ability of the three obturation systems. Samples were monitored every 24 hours for 65 days. Thirteen teeth leaked in both the Resilon/Epiphany and GP/AH Plus groups, whereas 17 teeth leaked in the ActiV GP/GI group at the end of the observation period. There were no statistically significant differences in the resistance to leakage between the three obturation systems (p > 0.05).

Is There an Association between Low Birth Weight and Caries in the Primary Dentition

Objectives: An association between low birth weight and caries in the primary dentition has been suggested but not demonstrated. This study analyzed this association using data from a probability sample of US children 2–6 years of age. Methods: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Variables included decayed and filled primary surfaces (dfs), birth weight, gestational age, and Apgar score (a surrogate measure of fetal well-being); maternal age, education, income; number of previous births, marital status, the existence of pregnancy complications, and cigarette smoking during the pregnancy. Data were analyzed using SUDAAN 8.0.2. Results: Bivariate Poisson regression showed that children of mothers who were unmarried (incidence density ratio, IDR = 3.28), with less education (IDR = 1.43), who were 17 years of age or younger at birth (IDR = 1.51), and had 2 or fewer prenatal visits (IDR = 1.65) had a significantly ( p <0.05) greater risk of caries than the reference groups. Children of mothers with pregnancy-related hypertension (IDR = 0.14) had less than 20% the risk of caries than the reference group. Blacks (IDR = 1.37) and Mexican-Americans (IDR = 2.38) had greater risk of caries than whites, and children of low (IDR = 2.57) and middle income (IDR = 2.00) level families had higher caries risks than those of upper income families. Multivariate Poisson regression found only race-ethnicity, age, and income level to be statistically significant. Conclusions: This study did not support the association between low birth weight and caries of the primary dentition.

The Association between Asthma and Dental Caries in Children and Adolescents: A Population–Based Case–Control Study

This study explored the potential association between childhood asthma and caries using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988–1994 (NHANES III). We fitted GEE Poisson regression models with adjustment for parents’ income, gender, race, exposure to potentially xerostomic drugs, and the presence of pit and fissure sealants. There was no association between the use of drugs commonly used by asthmatics (antihistamines, corticosteroids, and antiasthmatic inhalers) and df/DMF scores. Asthmatic children 4–10 years of age at all severity levels had similar dfs scores to the controls, however, severely asthmatic children 4–10 years of age had significantly lower DMFS (p = 0.010) and DMFT (0.049) scores than controls. Similarly, severely asthmatic children 11–16 years of age had significantly lower DMFT scores than controls (p = 0.024) and DMFS scores approaching statistical significance (p = 0.053). While our analysis adjusted for covariates, potential confounders such as fluoride intake from water, diet, use of topical fluorides, and dose of antiasthmatic medication could not be addressed. Our results indicate that any association between asthma and dental caries may occur primarily in younger children with no evidence of an association between asthma and dental caries as children mature.

Inclusion of tobacco exposure as a predictive factor for decreased bone mineral content.

Tobacco exposure has been implicated as a risk factor for decreased bone density, which might result in osteoporosis. Cotinine, a metabolite of nicotine, is commonly used as a marker for tobacco exposure (active or passive). The objective of the present study was to compare tobacco exposure with other predictive factors for low bone mineral content (BMC), as determined by dual photon bone absorptiometry (DXA) in a national U.S. sample. Publicly available interview and clinical examination data from the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES-III) were used. Our data included 14,060 subjects from 19,528 randomly selected representative U.S. households. Clinical laboratory data included serum values for calcium and cotinine. BMC was assessed radiologically by DXA at five proximal femur sites. BMC values were adjusted for age, as well as height, weight, and bone area to correct for bone and body size. We used t tests to compare continuous variables and chi-square tests to explore associations between categorical variables. Multivariate regression models were developed for each gender with appropriate covariates. Intertrochanter BMC explained the most variation (highest R 2 ) and was selected as the basis of the comparison. Serum cotinine had a significant inverse relationship to BMC in both males (p = .0069) and females (p = .0063). Serum cotinine, as a marker for tobacco exposure, is a statistically significant risk factor for decreased BMC in both genders and should be included in multivariate regression models to predict low BMC.

A Comparative Study of Root Coverage Using Two Different Acellular Dermal Matrix Products

BACKGROUND Gingival recession remains an important problem in dental esthetics. A new dermal matrix material has been introduced, but its effectiveness has not been studied and compared to current dermal matrix material. The aim of this study is to compare the healing associated with a coronally advanced flap for root coverage in areas of localized tissue recession when using Alloderm (ADM) and Puros Dermis (PDM). METHODS A split-mouth design was used for this study, with 52 contralateral sites in 14 patients with Miller Class I or III facial tissue recession. Twenty-six sites were treated with coronally advanced flap using PDM, and 26 sites were treated with coronally advanced flap using ADM, all followed for 6 months. Clinical measurements of vertical recession, keratinized tissue, probing depths, and attachment levels were made initially, at 3 months, and at 6 months. RESULTS Both groups had significant improvement in the amount of recession coverage with means of 2.83 mm for the PDM and 3.13 mm for the ADM. The percentage of root coverage was 81.4% for the PDM and 83.4% for the ADM; differences between the materials were not statistically significant. CONCLUSIONS Based on the results of this study, there was no statistical or clinical difference in the amount of root coverage, probing depth, or keratinized tissue in coronally advanced flaps for root coverage with either of the two acellular dermal matrix materials. Both materials were successful in achieving root coverage.

Socio-Demographic Features and Fluoride Technologies Contributing to Higher Fluorosis Scores in Permanent Teeth of Canadian Children

Objective: To examine levels of fluorosis among children in two Canadian communities exposed to flouride. Background: One community had discontinued flouride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized. Methods: We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires. Results: Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education. Conclusions: Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.

Tooth–Surface Progression and Reversal Changes in Fluoridated and No–Longer– Fluoridated Communities over a 3–Year Period

Objective: To compare permanent tooth surface–specific progression/reversal changes between fluoridation–ended (F–E) and still–fluoridated (S–F) communities in British Columbia, Canada, over a 3–year period. Methods: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. Results: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit–and–fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F–E site compared to the S–F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F–E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. Conclusion: Progressions were found to be weakly linked to socio–demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F–E communities had more frequent progressions than a S–F community.

Dental Health Care of Prison Populations

The purpose of this report was twofold: to examine the characteristics of dental care provided to state prisoners, and to determine if dental care in correctional settings was driven by traditional indicators such as state wealth, state social spending patterns, Department of Corrections (DOCs) annual medical expenditures, size of inmate populations, and the regional influence of surrounding state prison systems. Survey forms were sent to the DOCs of 50 states and the District of Columbia in 1996. Information was requested about the level of care, scope of care, clinician-to-inmate ratio, and administrative policies. Bivariate Pearsons correlations were performed using calculated inmate-to-dentist ratios and the traditional indicators previously mentioned. Mean inmate-to-dentist ratios were calculated by region, and an analysis of variance was performed to determine regional influences. DOCs were also grouped by size and by geographic location. Fisher Exact Tests were performed to determine whether DOC size and regional groupings were significant determinants influencing dental care. Forty-five states and the District of Columbia returned surveys (88%). Seventy-three percent of respondents had dental directors that coordinated dental care. Seventy-two percent described their DOCs as providing emergency care and some routine care. Fifty-two percent required inmates to make a co-payment for dental services. Twenty-six percent indicated that their states were providing dental care through managed care. There were no correlations between the level of care that inmates received and hypothesized indicators. There was substantial variation in the way dental care was provided to inmate populations by the states.

The Oral Health Needs of the Incarcerated Population: Steps Toward Equal Access

The author discusses the oral health needs of incarcerated individuals. Topics include a report on the oral health of Americans issued by the Assistant Secretary of Health and Surgeon General David Satcher in 2000, the lack of national data sets and surveys on institutionalized populations, and the impact of oral health on overall health.