Journal of the Canadian Dental Association最新文献

Purpose: This study aimed to examine the oral health status of seniors residing in Providence Health Care (PHC) long-term care facilities in 2002 and 2012.

Methods: Staff dentists with the University of British Columbia Geriatric Dentistry Program made a complete oral health assessment of 799 elderly residents of 7 long-term care PHC facilities in 2002 and 381 residents in the 5 remaining PHC facilities in 2012. The 2012 data were divided into those for 275 residents who had received treatment in previous years and 106 new residents. All consenting residents were examined by dentists using the clinical oral disorder in elders (CODE) index detailing their medical and oral health status and medications. On completion of the oral health assessment, the dentist documented the need for specific dental treatment and reassessment.

Results: Comparing the cohorts from 2002 and 2012, the mean age of the residents who had CODE assessments increased from 85 years to 86 years, the proportion of men increased from 31% to 35%, the mean number of medical conditions per resident remained unchanged (2.6 to 2.5), but the mean number of prescribed medications has increased from 4.0 to 4.6. The percentage of residents with natural teeth increased from 56% to 76%. The proportion of edentulous residents recommended for denture-related treatment decreased from 21% to 10%. The 106 new residents in 2012 had higher treatment needs than the 275 original residents, but fewer required extractions than in 2002. Although the mean number of teeth per resident examined increased from 14.6 to 17.4 over the study period, the need for restorations remained at 20%, and the need for extraction of teeth decreased from 22% to 6%. The proportion of residents with healthy periodontium increased from 14% to 21%, but the need for dental hygiene services increased from 43% to 80%.

Conclusions: The profile of long-term care residents who consented to an oral health assessment changed over the first decade of the new millennium, with an increase in mean age and number of prescribed medications, number of retained natural teeth and the need for dental hygiene services, but a decrease in the need for extractions.

Objectives: To determine the number and diagnoses of caries-related complaints presenting at Canada's largest children's hospital emergency department (ED) and the costs associated with treatment over 5 years.

Methods: We carried out a retrospective review of the health records of all children who presented to The Hospital for Sick Children, Toronto, with caries-related emergency complaints from 1 January 2008 to 31 December 2012. A caries-related complaint was defined as a chief complaint of pain or swelling resulting from the sequelae of dental decay (reversible pulpitis, irreversible pulpitis, abscess or cellulitis), as recorded in the chart by the treating physician or dentist. Visit information included chief complaint, final diagnosis, treatment rendered and patient disposition at discharge. Decision Support Services, a hospital department that analyzes resource use and associated costs, calculated the institutional costs for the episodes of emergency care.

Results: There were 1081 visits over the 5-year period, with a 19% increase in visits over that time. The most common presenting complaint was pain (50.8%) and the most common diagnosis abscess (35.6%). A dentist was consulted for 60.0% of the children and dental treatment in the ED was provided for 25.9%. The mean cost of treatment per patient was Can$575.17 (95% confidence interval $501.91-$648.43).

Conclusions: Over the 5-year study period, dental visits to this tertiary care pediatric hospital increased. The most common complaint was pain, and the diagnosis for about a third of these cases was abscess. Dental consultation was often included in the management of these patients and the resultant cost of these visits was about Can$600/patient.

Objectives: Oral hairy leukoplakia (OHL) is caused by Epstein-Barr virus (EBV) and is often associated with HIV and other immunosuppressive conditions. It is rare in HIV-negative patients, but has been reported in patients who use immune-modulating medications (e.g., cyclosporine). The objectives of this study were to determine the occurrence of OHL in HIV-negative patients and report Langerhans cell counts in these lesions.

Study design: A series of 7 new cases of OHL among HIV-negative patients is described. Langerhans cells were counted using an immunoperoxidase stain for CD1a and light microscopy.

Results: The 7 patients were male, ranging in age from 26 to 69 years. Clinically, all lesions were diagnosed as leukoplakia on the lateral border of the tongue. Microscopic examination revealed hyperparakeratosis and candidiasis in some cases, acanthosis and a band-like zone with clearing of cells in the upper spinous layer, which were EBV-positive by in-situ hybridization. There was a significant decrease in Langerhans cell counts in OHL patients.

Conclusion: OHL can occur in HIV-negative patients.

Purpose: The hydrophilicity of some elastomeric impression materials has not been fully established. The purpose of this study was to measure and compare the advancing contact angle of water on the surface of several set elastomeric impression materials.

Materials and methods: We tested various consistencies of vinyl polysiloxane (VPS; Imprint 4) and vinyl polyether silicone (VPES; EXA'lence) with a polyether (PE; Impregum Soft) control. Impression discs (25.07 mm) were made using a metal die and ring. Deionized ultra-filtered water was placed on each disc and contact-angle measurements were made at 0, 15, 30, 45 and 60 s using a video contact angle drop shape analysis machine. The data were analyzed using repeated ANOVA and a post-hoc test with Bonferroni correction.

Results: VPS contact angles reached a mean of 10.1° ± 0.2° at 60 s vs. 40.7° ± 0.1° for VPES. Overall, VPS contact angles were smaller than those for VPES at all measured times. However, heavy and super quick heavy VPS had much higher contact angles at 0 s compared with other VPS consistencies. There was a significant difference in contact angles between VPS and VPES (mean difference 33.9°, p < 0.05) and between VPS and PE (mean difference 32.8°, p < 0.05) but not between VPES and PE (P = 0.196). VPS heavy and super quick heavy were significantly different from other VPS materials (p < 0.05), but not from each other (p = 1.00).

Conclusions: Set VPS is more hydrophilic than VPES. Contact-angle values of VPS indicated super hydrophilicity. VPES was hydrophilic, with measurements similar to the PE control. Thus, VPS impression materials may be excellent in terms of spreading and copying wet surfaces.

Objectives: To explore the psychosocial impacts of dentistry as described by patients.

Methods: I conducted 6 qualitative interviews with people whose access to dental care had been limited because of financial barriers, but who had recently undergone significant treatment through a dental outreach program.

Results: In addition to physical benefits (including improved sleep and diet), participants discussed how dental treatment led to a greater level of confidence and an improved self-concept. They provided powerful examples of how this confidence boost improved their social interactions and relationships. They also felt more confident about their employability.

Conclusion: The benefits of adequate dental care extend well beyond its physical and medical aspects. Dental health is connected inextricably with people's sense of self and social functioning. The far-reaching consequences of dentistry explored in this research raise questions about the inequalities in Canada's current system and the need to address them.

Objective: The aim of this study was to evaluate the accuracy of 3 thermosensitive microsensors that record "wear time" of removable oral appliances (OAs).

Methods: For in vitro testing, TheraMon (sensor T, n = 20), AIR-AID SLEEP (sensor A, n = 30) and DentiTrac (sensor D, n = 16) microsensors were placed in a water bath to simulate long and short durations of wear. Their accuracy was also assessed when they were embedded in 3 materials: acrylic, polyvinylchloride and thermoactive acrylic. In vivo testing included 14 volunteers, who wore maxillary retainers embedded with sensors A and D for 30 nights. Logs of appliance use were compared with readouts from the sensors.

Results: In the in vitro long duration of wear assessment, sensor A, with a mean absolute response difference (MARD) of 1.67 min. (SD 1.41), was significantly more accurate than sensor T (MARD 3.53 min., SD 9.80) and sensor D (MARD 4.48 min., SD 8.46). For short duration of wear, sensor A (MARD 1.41 min., SD 3.60) and sensor T (MARD 1.68 min., SD 7.64) were equal in accuracy and significantly better than sensor D (MARD 14.07 min., SD 10.20). The embedding material had no effect on the recording accuracies of the microsensors. In vivo, there was no significant difference between sensors A and D.

Conclusion: All 3 microsensors are highly accurate and reliable and can be used to record wear time of a removable OAs fabricated from various materials.

Oral appliances (OAs) are frequently used in orthodontics and for the treatment of obstructive sleep apnea. Because OAs can be inserted and removed by patients themselves, the patient's cooperation is a major component of effective treatment. In this review, we provide an overview of factors studied in the past that affect adherence to OA use in orthodontics and dental sleep medicine. We also describe future directions in adherence and the use of objective microsensor technology to measure adherence in these patients. Because removable oral appliances (OAs) can be inserted and removed by patients themselves, their cooperation and adherence to therapy are necessary to achieve success.1,2 Removable OAs, such as headgear, removable retainers and functional appliances, are used in orthodontics to correct malocclusions. In the field of sleep medicine, removable OAs are increasingly used as an option in the treatment of patients with obstructive sleep apnea (OSA).

The use of resin composites and adhesives in dental restorations is ubiquitous. However, the longevity of resin composites is less than that of comparable restorative materials, mainly because of higher fracture rates and greater prevalence of secondary caries. Dental resin composites and adhesives contain ester links, which are vulnerable to biochemical hydrolysis by esterase activity from human saliva and bacteria. In this article, we review biodegradation processes that occur in the oral cavity and their contribution to the premature failure of resin composites. Biodegradation causes deterioration of resin composite bulk and the composite-tooth interface and releases by-products, such as methacrylic acid, triethylene glycol and bishydroxy-propoxy-phenyl-propane. These by-products have been shown to affect cariogenic bacterial growth and virulence. A compromised restoration-tooth interface allows saliva and oral bacteria to infiltrate the spaces between the tooth and the composite, exacerbating the effects of biodegradation, undermining the restoration and leading to recurrent caries, hypersensitivity and pulpal inflammation. It is important to consider the biochemical stability of these materials to advance their chemistry beyond the current formulations and conceive more biochemically stable and better-performing dental resin composites and adhesives.

We examine the perspectives of 14 key informants with extensive knowledge of dental care provision in Canada regarding systemic factors that could push Canadians to participate in dental tourism. Drawing on interview discussions about Canadians' access to dental care and their participation in dental tourism, we identify systemic factors related to how dental care is financed and delivered, rising costs of dental care and consumerism in terms of their potential role in Canadians' decisions to purchase dental care abroad. Further research on individual experiences accessing and using dental care, both in Canada and abroad, could help provide a better understanding of how these factors are informing Canadians' decision-making regarding dental care and, as a result, access to needed care.