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Journal of Conservative Dentistry and... 2023Tooth wears in general term means loss of tooth structure. Tooth loss increases with age and thus causes difficulty in chewing and increased sensitivity. Wear facets on...
Tooth wears in general term means loss of tooth structure. Tooth loss increases with age and thus causes difficulty in chewing and increased sensitivity. Wear facets on the occlusal surface are subjected to high occlusal stresses leading to repeated dislodgment of the restoration. This article presents the use of bonded amalgam as a restorative material for restoring localized occlusal wear facets.
PubMed: 38292365
DOI: 10.4103/jcd.jcd_253_23 -
Cureus Jan 2024Xerostomia leads to great challenges for patients and dentists in managing and maintaining oral health due to the high risk of developing dental caries. We discuss a...
Xerostomia leads to great challenges for patients and dentists in managing and maintaining oral health due to the high risk of developing dental caries. We discuss a case of a 10-year-old male patient who presented with complaints of decayed teeth and difficulty chewing and swallowing food. He had bilateral congenital stenosis and stricture of lacrimal ducts and a family history of lacrimal gland agenesis and Hashimoto's disease. The diagnosis reached was agenesis of all major salivary glands confirmed by saliva testing and ultrasound examination of the glands. Comprehensive preventative, restorative, and maintenance protocols based on caries management by risk assessment (CAMBRA) were implemented, including fissure sealants, amalgam and composite resin restorations, professional and home-applied fluoride, chlorhexidine mouthwash, frequent water consumption, and two-monthly recalls. We were able to stabilize the patient's risk of dental caries for over three years. The implementation of stringent restorative, preventive, and maintenance protocols is key to improving and maintaining oral health in severe cases of xerostomia.
PubMed: 38274608
DOI: 10.7759/cureus.52923 -
Evidence-based Dentistry Mar 2024Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included....
DATA SOURCES
Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate".
STUDY SELECTION
Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008.
DATA EXTRACTION AND SYNTHESIS
Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions.
RESULTS
In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study.
CONCLUSIONS
When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.
Topics: Humans; Dental Caries Susceptibility; Dental Caries; Dentition, Permanent; Molar; Dental Amalgam
PubMed: 38253747
DOI: 10.1038/s41432-024-00973-0 -
Work (Reading, Mass.) Jan 2024Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant...
BACKGROUND
Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant exposure to dental practitioners. Hence, it is important to assess the risk created by Hg use in healthcare.
OBJECTIVE
To quantify airborne Hg vapour exposure and Hg levels in dental healthcare workers, and determine the association of various symptoms and diseases to Hg exposure.
METHODS
Air monitoring of Hg vapours were conducted in dental clinics and amalgam rooms. Urine samples were collected from occupationally exposed dental healthcare workers and urine Hg levels were measured. A cross-sectional health survey was conducted in 23 healthcare units of Delhi to determine an association between Hg exposure and various health effects.
RESULTS
Hg vapour concentration ranged from 0.96μg/m3 to 15μg/m3, the highest concentration was recorded in the amalgam room (15μg/m3). Urine Hg levels in healthcare workers (0.51±0.17μg/L) were higher than the control (0.29±0.05μg/L). A cross-sectional health survey revealed a significant prevalence of confusion, forgetfulness, muscle spasm, and tremors by the respondents.
CONCLUSION
Hg concentration in dental clinics may hover above the prescribed safe levels posing a definitive health risk to healthcare workers. Urinary Hg measurements did not reveal an excess of body burden except in one case. Since Hg bio accumulates, it is probable as these workers grow older, they may end up with a higher body burden of Hg that may lead to a variety of adverse health outcomes.
PubMed: 38251084
DOI: 10.3233/WOR-230109 -
Journal of Functional Biomaterials Dec 2023With the phase-out of amalgam and the increase in minimally invasive dentistry, there is a growing need for high-strength composite materials that can kill residual...
With the phase-out of amalgam and the increase in minimally invasive dentistry, there is a growing need for high-strength composite materials that can kill residual bacteria and promote tooth remineralization. This study quantifies how antibacterial polylysine (PLS) and re-mineralizing monocalcium phosphate monohydrate (MCPM) affect biofilms and the strength of dental composites. For antibacterial studies, the MCPM-PLS filler percentages were 0-0, 8-4, 12-6, and 16-8 wt% of the composite filler phase. Composite discs were immersed in 0.1% sucrose-supplemented broth containing (UA159) and incubated in an anaerobic chamber for 48 h. Surface biomass was determined by crystal violet (CV) staining. Growth medium pH was measured at 24 and 48 h. Biofilm bacterial viability (CFU), exo-polysaccharide (water-soluble glucan (WSG) and water-insoluble glucan (WIG)), and extracellular DNA (eDNA) were quantified. This was by serial dilution plate counting, phenol-sulfuric acid microassay, and fluorometry, respectively. The biaxial flexural strengths were determined after water immersion for 1 week, 1 month, and 1 year. The MCPM-PLS wt% were 8-4, 8-8, 16-4 and 16-8. The normalized biomass, WSG, and WIG showed a linear decline of 66%, 64%, and 55%, respectively, as the PLS level increased up to 8%. The surrounding media pH (4.6) was all similar. A decrease in bacterial numbers with the 12-6 formula and a significant reduction with 16-8 compared to the 0-0 formulation was observed. The eDNA concentrations in biofilms formed on 12-6 and 16-8 formulations were significantly less than the 0-0 control and 8-4 formulations. Doubling MCPM and PLS caused a 14 and 19% reduction in strength in 1 week, respectively. Average results were lower at 1 month and 1 year but affected less upon doubling MCPM and PLS levels. Moreover, a 4% PLS may help to reduce total biomass and glucan levels in biofilms on the above composites. Higher levels are required to reduce eDNA and provide bactericidal action, but these can decrease early strength.
PubMed: 38248680
DOI: 10.3390/jfb15010013 -
Iranian Endodontic Journal 2024This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and...
INTRODUCTION
This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months.
MATERIALS AND METHODS
A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05.
RESULTS
Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (>0.05).
CONCLUSIONS
Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term.
PubMed: 38223838
DOI: 10.22037/iej.v19i1.43894 -
Anesthesia Progress Dec 2023This case report describes a 51-year-old man who swallowed an amalgam fragment dislodged during dental treatment performed without a throat screen. The patient was...
This case report describes a 51-year-old man who swallowed an amalgam fragment dislodged during dental treatment performed without a throat screen. The patient was transferred to the emergency department, where the foreign body was confirmed to be in the esophagus following radiographic imaging. Foreign body removal from the esophagus is routinely achieved via esophagogastroduodenoscopy (EGD). However, this incident occurred in September 2020, at the height of the COVID-19 pandemic. Because of the patient's preoperative positive COVID-19 test, the option for EGD retrieval was eliminated per hospital protocol. Instead, a noninvasive approach with serial radiographic monitoring was deemed mandatory to observe the fragment as it passed through the gastrointestinal tract, warranted by the small size of the foreign body and the patient's lack of signs and symptoms of respiratory distress. This case report reinforces the importance of using airway protection during every dental procedure. Furthermore, reevaluation of EGD as the gold standard for treatment of ingested small materials may be warranted.
Topics: Male; Humans; Middle Aged; Pandemics; COVID-19; Foreign Bodies
PubMed: 38221701
DOI: 10.2344/anpr-70-03-03 -
International Dental Journal Feb 2024
Topics: Humans; Dental Amalgam; Dental Materials; Composite Resins; Glass Ionomer Cements; Dental Restoration, Permanent; Materials Testing; Resin Cements
PubMed: 38218597
DOI: 10.1016/j.identj.2023.10.006 -
Brazilian Oral Research 2024The aim of this study was to analyze the expression of mast cell markers toluidine blue, c-kit, and tryptase and presence of mononuclear inflammatory cells in oral...
The aim of this study was to analyze the expression of mast cell markers toluidine blue, c-kit, and tryptase and presence of mononuclear inflammatory cells in oral lichen planus (OLP) and oral lichenoid lesions related to dental amalgam. Nineteen specimens of OLP, OLLC, and healthy oral mucosa were selected. Mononuclear inflammatory cells were analyzed. Histochemical and immunohistochemical analyses were performed using toluidine blue, anti-c-kit and anti-tryptase reagents, and the results were quantified in areas A and B of connective tissue. Mast cells of all OLP and OLLC samples were positive for toluidine blue, c-kit, and tryptase. The density of toluidine blue+, c-kit+ and tryptase+ mast cells was higher in tissue with OLP and OLLC compared with healthy controls (p < 0.05). No difference was noted in mast cells density between OLP and OLLC (p > 0.05). The density of tryptase+ mast cells was higher in the subepithelial region (area A) than the region below it (Area B) in OLLC (p = 0.047). The mononuclear inflammatory cell density was higher in OLLC compared to OLP, but without statistical significance (p > 0.05). A positive statistical correlation was found between mononuclear immune cells and density of c-kit+ and tryptase+ mast cells in OLP (r = 0.943 and r = 0.886, respectively). Our data demonstrate that the etiopathogenesis process of OLP and OLLC modulates the expansion and degranulation of mast cells; mast cells density, however, was similar between OLP and OLLC. The distribution of mast cells appears to vary along the lamina propria.
Topics: Humans; Mast Cells; Lichen Planus, Oral; Dental Amalgam; Tolonium Chloride; Tryptases
PubMed: 38198305
DOI: 10.1590/1807-3107bor-2024.vol38.0005 -
Pakistan Journal of Medical Sciences 2024Green dentistry is an emerging concept necessary to address the worsening climatic changes. It is essential to compile the existing literature on knowledge, attitude,... (Review)
Review
OBJECTIVE
Green dentistry is an emerging concept necessary to address the worsening climatic changes. It is essential to compile the existing literature on knowledge, attitude, and practice on green dentistry that can be accomplished by conducting a literature review. The objective of this literature review was to summarize and present the existing knowledge that dentists have regarding green dental practices, their attitude about this shift towards sustainability, and steps that they have taken in their personal practice to adhere towards an eco-friendlier dental approach.
METHODS
Three months of effective research and review development from March 2022 to June 2022. Design using keywords, a literature search was performed in PubMed, Google scholar and Web of Science databases. A total of 13 articles of 45, fulfilling the inclusion criteria were selected, of which two were excluded as these were not in English.
RESULTS
Dental practitioners have good knowledge about green dentistry and positive attitudes towards environment conservation, but implementation in their practice is not adequate. Most common themes of knowledge, attitude and practice assessment in green dentistry are amalgam management, radiographic management, infection control, waste management, water, and electricity management.
CONCLUSION
The absence of adequate literature on eco-friendly practices in dentistry makes it difficult to validate the findings of most of these studies. Dental professionals are familiar with environmentally friendly dental practices and have a positive outlook on their role in environmental protection, but its application in practice is far from adequate.
PubMed: 38196463
DOI: 10.12669/pjms.40.1.7606