Quintessence International, 06/2005

Objective: The aim of this in vitro study was to compare the performance of a laser fluorescence device (DIAGNOdent) and a caries-detector dye for detecting residual dentinal caries. Methods and Materials: Forty extracted human molar teeth with deep dentinal carious lesions on their approximal surfaces were used for the study. The caries were removed by a new chemomechanical system, Carisolv. Three independent observers checked all cavities for residual caries using caries-detector dye and DIAGNOdent. The presence or absence of residual caries was verified using polarized light microscopy as the gold standard. Three observers recorded two different measurements at the same site after 2 weeks to determine intra- and interexaminer reproducibility of the DIAGNOdent. Results: Average kappa values of 0.61 for interexaminer reproducibility and 0.94 for intraexaminer reproducibility were determined. The specificity of caries-detector dye was found to be 100% and the specificity of the DIAGNOdent was 86%. Conclusion: Although DIAGNOdent showed greater sensitivity than caries-detector dye (P .05), low sensitivity values for each diagnostic system may lead to teeth with residual caries being undetected. Therefore, it might be advisable to reconsider the criteria for detecting residual caries during tooth preparation. Keywords: caries-detector dye, Carisolv, DIAGNOdent, residual dentinal caries

Lymph node enlargement may be an incidental finding on examination, or may be associated with a patient complaint. It is likely that over half of all patients examined each day may have enlarged lymph nodes in the head and neck region. There are no written guidelines specifying when further evaluation of lymphadenopathy is necessary. With such a high frequency of occurrence, oral health care providers need to be able to determine when lymphadenopathy should be investigated further. Although most cervical lymphadenopathy is the result of a benign infectious etiology, clinicians should search for a precipitating cause and examine other nodal locations to exclude generalized lymphadenopathy. Lymph nodes larger than 1 cm in diameter are generally considered abnormal. Malignancy should be considered when palpable lymph nodes are identified in the supraclavicular region, or when nodes are rock hard, rubbery, or fixed in consistency. Patients with unexplained localized cervical lymphadenopathy presenting with a benign clinical picture should be observed for a 2- to 4-week period. Generalized lymphadenopathy should prompt further clinical investigation. This article reviews common causes of lymphadenopathy, and presents a methodical clinical approach to a patient with cervical lymphadenopathy. Keywords: cervical lymphadenitis, cervical lymphadenopathy, clinical evaluation, differential diagnosis, head and neck lymphadenopathy, lymphadenitis, lymphadenopathy, medications and lymphadenopathy, toxoplasmosis

This paper, the third in the series, initially details the role of the restorative dentist in treating patients with hypodontia. (See Quintessence Int 2005;36:263-270 and 345-353 for the first two papers.) A range of treatment options, including implants, adhesive techniques, and removable prostheses, are covered. The investigators have detailed the clinical indications, and noted their relative advantages and disadvantages. Keywords: hypodontia, implants, orthodontics, prosthesis, resin-bonded prostheses, restorative

Objective: Previous studies have shown that endotoxins are located on the periodontally diseased root cementum and not within it. To what extent a Teflon-tubed sonic scaler was capable of removing bacterial deposits in comparison to conventional scaling instruments, and the resulting root surface roughness and root surface topography, were recently assessed. The objective of the present study was to evaluate how much root cementum is removed with these instruments. Methods and Materials: Eighty-two teeth were treated subgingivally on one approximal site either with a Teflon-coated sonic scaler insert (tSS), a Gracey curette, a conventional sonic scaler (SS), a piezoelectric ultrasonic scaler insert (US), or an oscillating Periotor insert (PT) before extraction. The untreated site served as control. The width and length of cementum removal were compared histomorphometrically. Nonparametric analyses were carried out for statistical comparison. Results: The US, PT, and tSS inserts removed less substance than the curettes or SS inserts. The cementum removed was 40 µm for root surfaces treated with the curette or SS, 30 µm for those treated with US, 20 µm for PT, and 17 µm for tSS. Conclusion: The Teflon-coated sonic scaler inserts can be a reasonable choice for gentle maintenance treatment of compliant patients with good plaque control, and little or no subgingival deposits. Keywords: curette, debridement, subgingival polishing, substance removal, sonic instrument, ultrasonic

Objectives: The purpose of this investigation was to determine the thickness of different types of custom-made mouthguards after processing and the deformational changes after simulated occlusal loading. Materials and methods: Ten mouthguards were fabricated for the same dental arch using the following materials and processing techniques: Group I: vacuum-formed (4 mm), Colored Mouthguard; Group II: vacuum-formed (4 mm), Proform; and Group III: pressure-laminated (3 + 3 mm), Drufosoft. After processing, the thickness was measured in three places: lingual cusps of the first molar, distal marginal ridge of the first premolar; and facial of central incisor. The stiffness of each group was determined by applying a simulated clenching force to the first molar lingual cusp areas on an Instron test machine with a blunt probe. The corresponding penetration was measured with a dial gauge. Thickness and force-deflection measurements of the different mouthguard groups were compared using analysis of variance and post hoc tests. Results: The mean thicknesses at the molar for Groups I and II were 1.55 and 1.52 mm, respectively, and were significantly smaller then the corresponding thickness for Group III (3.48 mm). The mean thicknesses at the facial of the incisors for Groups I and II were similar (2.05 and 2.06 mm, respectively), and were significantly smaller than the corresponding thickness for Group III (3.29 mm). Groups I and II demonstrated similar stiffness that was significantly higher than that for Group III. Conclusion: These results show that vacuum-formed mouthguards produced smaller thicknesses than the pressure-laminated mouthguards. The pressurelaminated mouthguards produced material thicknesses that were previously shown to be adequate to protect athletes from trauma. Keywords: custom-made, mouthguard, pressure-laminated, stiffness, thickness, vacuum-formed

Objective: The aim of this study was to evaluate, in vitro, the cariostatic effect of whitening toothpastes. Methods and Materials: Ninety-five dental fragments were obtained from nonerupted third molars. The fragments were embedded in polystyrene resin and sequentially polished with abrasive papers (400-, 600-, and 1,000-grit) and diamond pastes of 6, 3, and 1 µm. The fragments were assigned in five groups according to toothpaste treatment: G1 = Rembrandt Plus with Peroxide; G2 = Crest Dual Action Whitening; G3 = Aquafresh Whitening Triple Protection; and the control groups: G4 = Sensodyne Original (without fluoride); G5 = Sensodyne Sodium Bicarbonated (with fluoride). The initial enamel microhardness evaluations were done. For 2 weeks the fragments were submitted daily to a de-remineralization cycle followed by a 10-minute toothpaste slurry. After that, the final microhardness tests were done. The percentage of mineral loss of enamel was determined for statistical analysis. Analysis of variance and the Tukey test were applied. Results: The results did not show statistically significant differences in mineral loss among groups G1, G2, G3, and G5, which statistically differ from G4 (toothpaste without fluoride). G4 showed the highest mineral loss (P = .05). Conclusion: The whitening toothpastes evaluated showed a cariostatic effect similar to regular, nonwhitening toothpaste. Keywords: caries, dental bleaching, enamel, hydrogen peroxide, microhardness, mineral loss, whitening toothpastes

Objective: The purpose of this study was to determine the level of glycemic control in dental patients with diabetes upon admission to a dental school clinic. Methods and Materials: One hundred patients (mean age: 57.7 years) of the Oral Diagnosis-Admissions Clinic at the University of Minnesota School of Dentistry, Minneapolis, Minnesota, with diabetes mellitus were chosen as subjects. Fasting blood glucose was measured using a portable blood glucose monitoring device as a part of their initial dental examination. Results: Twenty-eight of the 100 patients were found to be hyperglycemic (>= 126 mg/dl; 174.8 ± 40.8 mg/dl; mean ± SEM); 2 patients were found to be hypoglycemic ( 70 mg/dl). Of the 8 patients with type 1 diabetes in the cohort, 3 (37.5%) were very hyperglycemic, with fasting blood glucose levels > 250 mg/dl. Conclusions: This is important information for dental practitioners because patients with diabetes may not be under good glycemic control, and dentists may have to take special precautions before, during, and after treatment. This paper reviews the pathogenesis of diabetes, the detection of patients with undiagnosed or poorly controlled diabetes, and the management of patients with diabetes during dental treatment. Keywords: blood glucose, diabetes, diabetes mellitus, dentistry, infections, hyperglycemia, hypoglycemia, insulin

Hemifacial hyperplasia is a developmental disorder characterized by a marked unilateral asymmetry. The etiology is unknown, although several factors have been described. It involves not only the hard tissues of the face, but the soft tissues as well. A case report of an adult woman with hemifacial hyperplasia highlighting the clinical significance is presented. Keywords: congenital anomaly, development disorder, hemifacial asymmetry, hemifacial hyperplasia, hemifacial hypertrophy, osteotomies