Monographs in Oral Science最新文献

Research in animal models, particularly rodents, has been used as a tool for gaining insight into the genetics contribution to dental caries. This chapter dissects some of these data, particularly the early studies motivated by observations in humans, complementing them with more recent ones designed specifically to map genes for dental caries. Finally, it offers a critical view of the rationale and lack of ethical principles of the use of nonhuman species in research.

Erosive tooth wear is the classic gene-environmental model. It requires the exposure to acids, typically from the diet or from the gastric content of the host, and shows variation among individuals and populations, which suggests it to be determined by more than one gene, each with small individual effects. This genetic component is not easily studied since a precise assessment of acidic exposure is complicated. In humans, this is commonly done by self-reported data. In this chapter, evidence is discussed that supports the assumption that a genetic component exists, inspecting data from wine tasters, and ex vivo experiments combining different dental enamel specimens and saliva compositions. These data can be found "hidden" in reports that do not directly deal with individual susceptibility to erosive tooth wear.

A dietary pattern rich in refined sugars is associated with higher caries experience. However, people show differences in references for certain foods, and these differences are genetic in origin. In this chapter, dietary preference is the focus of the discussion of individual susceptibility to dental caries and erosive tooth wear.

During the last decade, photodynamic therapy (PDT) has been extensively investigated for the treatment of periodontal and peri-implant infections. Nonetheless, contradicting clinical and microbiological outcomes and only results on a short-term basis have been reported so far, thus making it difficult to conclude on clinically relevant recommendations for the use of PDT. Therefore, the aim of this narrative review is to provide an overview of the current evidence from randomized controlled clinical trials (RCTs) evaluating the potential clinical and/or microbiological benefit for the use of PDT in non-surgical periodontal and peri-implant therapy, and to draw clinically relevant conclusions on the use of PDT in periodontal practice. Based on the available evidence from RCTs and recent meta-analyses, we can conclude the following: in patients with mild to moderate periodontitis, the combination of scaling and root planing (SRP) and PDT may result in significantly higher clinical improvements (bleeding on probing and probing depth reduction, clinical attachment gain) compared to SRP alone in the non-surgical treatment of periodontitis; in patients with stage III and IV grade C periodontitis (previously known as AgP) the use of PDT provides clinical improvements, although PDT cannot so far be recommended as a replacement for systemic antibiotics (i.e., amoxicillin and metronidazole); PDT may be indicated as a valuable tool for treating moderate residual periodontal pockets during maintenance therapy; limited evidence on the use of PDT in medically compromised patients (i.e., diabetes mellitus, oral lichen planus) indicates that PDT may represent a possible alternative to other more invasive medication/treatment procedures; limited evidence suggests that PDT may represent a valuable tool in attaining inflammation reduction on a short-term basis in peri-implant diseases (i.e., peri-implantitis, peri-implant mucositis).

The goal of modern periodontal therapy, both during the initial stages and during maintenance, is to create biologically acceptable tooth surfaces through sub- and supragingival cleaning, which enables binding of the connective tissue to the greatest extent possible. In past centuries, the focus of periodontal treatment was on the removal of the supposed cause of periodontal disease, the supra- and supragingival calculus and "infected" root cementum. The findings on the importance of biofilm1 (plaque) and the endogenous responses to biofilm metabolism have shifted the therapeutic focus to elimination of the biofilm. The importance of avoiding injury to the hard and soft dental tissue is nowadays of upmost importance. For classical scaling and root planing to remove mineralized deposits and "infected" cementum, only hand instruments were available in the past. The regular, long-term use of these tools is associated with changes in the hard and soft tooth tissues, and with pain and sensitivity experienced by the patient during and after treatment. Modern root-surface debridement primarily uses ultrasound systems to remove hard mineralized deposits. For biofilm management, air polishing devices with low-abrasive powders are increasingly gaining acceptance. With this new technology, biofilm management can now be performed much more effectively and efficiently, using materials more sparingly; this also causes less pain and discomfort for patients during and after treatment, and less fatigue for practitioners. The modern systems allow gentle, optimal biofilm management, whereas the traditional hand instruments (curettes, scalers) and classic rotating instruments used for polishing do not. Current knowledge suggests that these instruments are not best suited for biofilm management.

Dental caries is initiated by an unbalance between periods of demineralization and remineralization, and the consequence is localized loss of minerals right under the enamel surface of certain teeth that, if left to progress, may lead to irreversible loss of structure. One approach proposed to overcome the limitation of simply counting the number of teeth or surfaces affected by caries was to characterize the initial loss of minerals from the dental enamel in the laboratory as a way to phenotype individuals for genetic studies of dental caries or erosive tooth wear. This chapter discusses the results of these original studies.

When dental caries or erosive tooth wear lesions progress into dentin, the speed of their progression into the pulp will be modulated in part by the quality of the dentin physiology of the tooth. Some individuals may have dentin that allows for quicker progression of lesions, and therefore being more susceptible to the formation of periapical lesions, or even being more prone to loss of extensive restorations. This chapter discusses the results of the initial studies exploring phenotypes that consider manifestations of deep caries or erosive lesions in dentin.

When dental caries or erosive tooth wear lesions progress into dentin, the speed of their progression into the pulp will be modulated in part by the physiology of the dentin-pulp complex. In some individuals, this physiology allows for a quicker progression of the lesions. Research on the longevity of dental restorations has focused almost solely on the technical aspects needed to improve the adhesive properties and longevity of the restorations. Studying the possible individual variations in the quality of dental tissue may enable further developments targeting specific dental tissue phenotypes. This chapter discusses the results of the initial studies exploring phenotypes that consider manifestations of deep caries or erosive lesions in dentin.