[Show abstract][Hide abstract] ABSTRACT: Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities.
BMC Oral Health 08/2014; 14(1):98. · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. To analyze the efficacy of various partial-mouth recording (PMR) systems in the evaluation of periodontal status, using index teeth and different combinations of quadrants. Methods. The study group was formed of 108 adults aged between 25 and 65 years. A full-mouth examination was performed in all participants in order to determine the periodontal probing depth and attachment loss at six sites per tooth. The results of PMR using the Ramfjord teeth, the Community Periodontal Index of Treatment Needs (CPITN) teeth, and the four quadrants individually and combined in pairs were compared with the results obtained with full-mouth examination. Results. Concordance with the full-mouth examination in terms of the prevalence of patients with periodontal probing ≥4 mm, clinical attachment loss ≥2 mm and clinical attachment loss ≥4 mm was lowest with examination of single quadrants and highest with combinations that included one superior and one inferior quadrant. Conclusion. Partial-mouth recording systems, particularly with combinations of a superior plus an inferior quadrant, could be useful to evaluate periodontal status based on periodontal probing depth and attachment loss. This tool could be useful for epidemiological surveys on periodontal status.
Journal of Periodontology 11/2013; · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: The objective of this study was to analyse the antibacterial and antiplaque activity of three edible toothpastes with the widest worldwide distribution: KidScents™, which contains essential oils; Browning B& B™, with medicinal plants; and Wysong Probiodent™, which contains probiotics. Study Design: The study group was formed of twenty healthy volunteers (dental students) with a good oral health status. Using a balanced randomisation system, all volunteers performed toothbrushing with four products (the three edible toothpastes and water) at intervals of one week. Bacterial vitality in the saliva was analysed by epifluorescence microscopy and plaque regrowth was evaluated using the Turesky-Quigley-Hein plaque index. Results: Bacterial vitality in the saliva was significantly higher after toothbrushing with water (positive control) than with the three toothpastes (P=0.002, P=0.003 and P<0.001, respectively). The plaque index was significantly higher after using these three toothpastes than after toothbrushing with water (P=0.047, P=0.032 and P<0.001, respectively). Conclusions: The three edible toothpastes analysed have some antimicrobial activity but favour plaque regrowth.
[Show abstract][Hide abstract] ABSTRACT: Bisphosphonates have been associated with a serious adverse reaction known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this study was to describe its clinical characteristics in patients with dental implants who were taking bisphosphonates orally. We made a retrospective multicentre study in 3 hospitals in Galicia, Spain. The medical records and clinical and radiological follow-up of the oral cavity were reviewed for those patients given bisphosphonates and diagnosed with BRONJ after the placement of dental implants within the previous 3 years. The series comprised 9 white patients (mean age 66 years). The bisphosphonates were alendronate (n=6), ibandronate (n=2), and risedronate (n=1), and the most common indication was osteoporosis (n=7). The mean interval between the initiation of treatment and the onset of BRONJ lesions was 60 months. Most of the lesions were located around the mandibular implants (n=8). The mean interval between placement of dental implants and the onset of BRONJ was 34 (range 1-96) months. After treatment 7/9 patients recovered completely. The prevalence of BRONJ secondary to treatment with bisphosphonates taken orally after placement of dental implants may be higher than expected in a particular geographical region, but to date specific risk factors have not been identified. Clinical characteristics and the outcomes of treatment of lesions are similar to those seen in patients with BRONJ that is unrelated to placement of dental implants.
British Journal of Oral and Maxillofacial Surgery 07/2013; · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: To identify the 100 most cited articles published in dental journals. MATERIALS AND METHODS: A search was performed on the Institute for Scientific Information (ISI) Web of Science for the most cited articles in all the journals included in the Journal Citation Report (2010 edition) in the category of "Dentistry, Oral Surgery, and Medicine". Each one of the 77 journals selected was analyzed using the Cited Reference Search tool of the ISI Web of Science database to identify the most cited articles up to June 2012. The following information was gathered from each article: names and number of authors, journal, year of publication, type of study, methodological design, and area of research. RESULTS: The number of citations of the 100 selected articles varied from 326 to 2050. All articles were published in 21 of the 77 journals in the category. The journals with the largest number of the cited articles were the Journal of Clinical Periodontology (20 articles), the Journal of Periodontology (18 articles), and the Journal of Dental Research (16 articles). There was a predominance of clinical research (66 %) over basic research (34 %). The most frequently named author was Socransky SS, with 9 of the top 100 articles, followed by Lindhe J with 7. The decades with most articles published of the 100 selected were 1980-1989 (26 articles) and 1990-1999 (25 articles). The most common type of article was the case series (22 %), followed by the narrative review/expert opinion (19 %). The most common area of study was periodontology (43 % of articles). CONCLUSIONS: To our knowledge, this is the first report of the top-cited articles in Dentistry. There is a predominance of clinical studies, particularly case series and narrative reviews/expert opinions, despite their low-evidence level. The focus of the articles has mainly been on periodontology and implantology, and the majority has been published in the highest impact factor dental journals. CLINICAL SIGNIFICANCE: The number of citations that an article receives does not necessarily reflect the quality of the research, but the present study gives some clues to the topics and authors contributing to major advances in Dentistry.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To investigate whether there is a relationship between the oral hygiene habits of individuals with severe disability the carer's personal appearance and interest in oral health. PATIENTS AND METHODS: The study group was formed of 60 disabled persons and their respective carers who came for the first time to consultation in the Special-Needs Dentistry Unit of the University of Santiago de Compostela, Spain. All the carers answered a standardised questionnaire of 28 questions divided into four sections: disabled individual's demographic data, disabled individual's general medical details, social aspects of the carer (personal appearance of the carer and interest in oral health), and disabled individual's oral hygiene habits. The personal appearance of the carers and their interest in the disabled individual's oral health were evaluated using independent scales designed specifically for the study, with five binary items in each scale. RESULTS: The carer's personal appearance and interest in the disabled individual's oral health showed a statistically significant relationship with the individual's oral hygiene habits, particularly with respect to the frequency and duration of toothbrushing, need for physical restraint during toothbrushing, use of a manual toothbrush and use of toothpaste. CONCLUSIONS: The carer's personal appearance and interest in the disabled individual's oral health are good indicators of the oral hygiene habits of an individual with severe disability. Consideration should be given to the inclusion of these aspects as a complementary element of the dental record.
International Journal of Dental Hygiene 06/2013; · 0.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To determine hepatitis C virus (HCV) RNA clearance from blood and saliva of HIV-HCV-coinfected patients undergoing combined therapy with pegylated interferon plus ribavirin (PEG-IFN-RIB). SUBJECTS AND METHODS: Study group was formed of 60 HIV-infected patients with chronic hepatitis C who were starting treatment with PEG-IFN-RIB. Blood and saliva samples were taken at baseline, at the end of treatment and 24 and 48 weeks later. A nested RT-PCR technique was used to detect HCV-RNA in saliva. RESULTS: HCV-RNA was detected in saliva at baseline in 64.7% of patients. Thirty-four patients completed follow-up. The response rate (undetectable HCV-RNA) in blood was 79.4% at the end of treatment; 55.8% at 24 weeks after the end of treatment and 50% at 48 weeks. HCV was detected in saliva of 13 (38.2%) patients at the end of treatment and in 18 (52.9%) patients at 24 and 48 weeks later. Concordance of HCV clearance from blood and saliva reached its maximum value at 48 weeks after the end of treatment (odds ratio, 112.51). CONCLUSION: In HIV-HCV-coinfected patients responders to PEG-IFN-RIB, the salivary glands do not appear to be a sanctuary site for HCV, although viral clearance from saliva may be slower than from blood.
[Show abstract][Hide abstract] ABSTRACT: Objectives: In this paper we propose a new Global Oral Health Scale that will allow the infectious potential of the oral cavity, clinically manifest as local and focal infections, to be condensed into a single parameter. Study design: Based on a number of oral health scales previously designed by our group, we designed a final version that incorporates dental and periodontal variables (some of them evaluated using corroborated objective indices) that reflect the presence of caries and periodontal disease. Results: The application of the proposed oral health scale requires the examination of 6 sites per tooth (mesio-buccal, medio-buccal, disto-buccal, disto-lingual, medio-lingual and mesio-lingual). The following variables are analysed: number of tooth surfaces with supragingival plaque, determined using the O'Leary index; number of teeth with caries and the severity of the caries; number of tooth surfaces with gingival inflammation, determined using the Ainamo and Bay index; and number of tooth surfaces with pockets ≥4 mm and severity of the pockets. These variables are then grouped into 2 categories, dental and periodontal. The final grades of dental and periodontal health correspond to the grades assigned to a least 2 of the 3 variables analysed in each of these categories. The category (dental or periodontal) with the highest grade is the one that determines the grade of the Global Oral Health Scale. Conclusion: This scale could be particularly useful for the epidemiological studies comparing different populations and for analysis of the influence of distinct degrees of oral health on the development of certain systemic diseases.
[Show abstract][Hide abstract] ABSTRACT: Objective: To compare the results of a subjective estimation of oral health through review of a set of intraoral photographs with those of an objective oral health scale of infectious potential. Method: The pool of patients was made up of 100 adults. Using an infectious-potential scale based on dental and periodontal variables, we assigned 1 of the 4 grades of the scale (range, 0 to 3; 0 corresponds to an excellent oral health status and 3 to the poorest oral health status) to each subject. A total of 20 representative subjects were selected from the pool of patients, 5 subjects for each one of the grades of the scale, and a standardized photographic record was made. One thousand dentists practicing in Spain were sent the survey by e-mail and 174 completed forms were received. We then calculated the concordance of the oral health status indicated by the respondents after visualising the photographs on comparison with the results of the oral health scale of infectious potential; concordance was termed correct grade allocation (CGA). Results: The majority of respondents (69.1%) achieved a CGA in 8 to 12 cases and none achieved more than 15 CGAs. The poorest CGA rates were found with grades 1 and 2, with a mean of 1.74 ± 1.09 and 1.87 ± 1.18, respectively, out of a maximum of 5. The concordance in terms of CGA was high for grade 0 (70.5%), very low for grade 1 (10.8%), low for grade 2 (37.3%), and moderate for grade 3 (42.6%). Conclusion: In comparison with visual examination of the oral cavity, the use of objective scale that establishes a reliable diagnosis of oral health in terms of infectious potential was found to be advantageous.
[Show abstract][Hide abstract] ABSTRACT: Objectives: To describe a new bench model for oral precancer/cancer biopsy training and to assess its effectiveness in terms of trainees' perception. Study design: Cross-sectional, descriptive, performed on 424 general dental practitioners (GDP) who undertook biopsies on a pig tongue. The participants were assessed by direct observation for 2.5 hours using specific check-lists and by means of a self-applied questionnaire. Results: The workshop was perceived as "very interesting" even by those with previous surgical experience (Xi - Xj = 0.07; 95%CI= -0.20-0.09). Most GDPs considered themselves able to undertake oral biopsies on real patients after the workshop. Those who had previously received theoretical continuous education courses on oral biopsy scored higher values within the group (Xi - Xj = 0.20; 95%CI= 0.04-0.37). Conclusions: There is a need for including clinical abilities workshops when instructing on oral biopsy techniques. More studies are needed to validate the procedure and to address cognitive and communication skills.
[Show abstract][Hide abstract] ABSTRACT: Background. To assess in situ substantivity of a single mouthrinse with 0.2% Clorhexidine (CHX) on saliva and on undisturbed de novo plaque-like biofilm (PL-biofilm), differentiating between 2 times of application: CHX mouthrinse in the morning and CHX mouthrinse at night. Methods. The study subjects were 10 healthy volunteers who wore an individualized splint with glass disks for 48 hours to boost the growth of PL-biofilm. Saliva samples were collected and 2 disks were removed from each volunteer's splint at 8, 10, and 12 hours after performing a mouthrinse with 0.2% CHX at 7 AM (M-0.2% CHX-diurnal) and 1 AM (M-0.2% CHX-nocturnal). The saliva and plaque samples were analyzed by epifluorescence and confocal laser scanning microscopy, respectively, using SYTO 9/propidium iodide staining. Results. With M-0.2% CHX-diurnal, the frequency of vital bacteria in saliva was significantly higher than in the PL-biofilm at 8, 10, and 12 hours post-mouthrinse. After M-0.2% CHX-nocturnal, the frequency of vital bacteria in saliva was significantly lower than in the PL-biofilm at 8 hours and higher than in the PL-biofilm at 12 hours post-mouthrinse. Conclusions. These results support the more active physiologic dynamics of the salivary flora and the possible reservoir function associated with the structure of undisturbed de novo PL-biofilm.
Journal of Periodontology 01/2013; · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: It has been suggested that some local and systemic factors could be contraindications to dental implant treatment. The objective of this paper was to evaluate whether success and survival rates of dental implants are reduced in the medically compromised patient. DATA/SOURCES: An extensive literature search was conducted using PubMed/Medline, Scopus, Scirus and Cochrane databases up to November 8, 2012. CONCLUSIONS: There are very few absolute medical contraindications to dental implant treatment, although a number of conditions may increase the risk of treatment failure or complications. The degree of systemic disease-control may be far more important that the nature of the disorder itself, and individualized medical control should be established prior to implant therapy, since in many of these patients the quality of life and functional benefits from dental implants may outweigh any risks.
[Show abstract][Hide abstract] ABSTRACT: Osteonecrosis of the jaw (ONJ) is a debilitating chronic illness that has become one of the literature's most discussed adverse events in relation to advanced malignancy. In 2010, the first case reports of ONJ linked with denosumab administration were published.
The authors describe a case of denosumab-related ONJ in a 73-year-old man with a diagnosis of prostatic adenocarcinoma, the treatment for which included the antiresorptive agent denosumab and who experienced severe pain and delayed healing after a mandibular molar extraction performed six months after the cessation of denosumab therapy. The patient had not received radiotherapy to the head and neck, nor had he received any bisphosphonate treatment.
Clinicians established a diagnosis of denosumab-related ONJ. Follow-up across 12 months revealed that the patient needed long-term courses of antibiotics and that he experienced progressive bone destruction requiring surgical debridement.
The authors suggest that in patients receiving denosumab therapy, the dosing interval, the cumulative dose or both may be important in terms of the development of denosumab-related ONJ. This allows the hypothesis that preventive dentistry may reduce the prevalence of ONJ in those receiving denosumab as it has in those receiving bisphosphonates.
Journal of the American Dental Association (1939) 09/2012; 143(9):981-4. · 1.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Continuing education (CE) can have a large impact on dentists' oral cancer attitudes, knowledge, and behavior. Reading scientific journals is a key component of CE. The objective of this study was to assess preventive and clinical attitudes of the participants in an educational intervention on oral cancer in Spain based on scientific journals. Members of the Spanish Board of Dentists and Stomatologists participated in an online, cross-sectional study, using an anonymous, self-administered questionnaire. There were 791 general dental practitioners (GDPs) invited to participate in the study. The large majority reported that they deliver tobacco-cessation counseling (93.6 percent) as well as advice on alcohol consumption (66.6 percent), but advice on vegetable intake was less frequently provided (42.4 percent). Alcohol intake advice, routine mucosa exploration, and biopsy performance on lesions suspicious of malignancy are preventive attitudes related to training. Compared with those who did not benefit from CE courses or did so only once, the GDPs who took four or more CE courses showed a doubling in the odds of giving alcohol advice to their patients and a tenfold increased odds of performing mucosa check on a routine basis; they were 3.5 times as likely to take biopsies of suspicious lesions. A longer experience as a GDP did not increase the probability of adopting preventive attitudes. In addition to presenting the results of this study, the article also discusses the general usefulness of other preventive measures in oral cancer.
Journal of dental education 09/2012; 76(9):1234-40. · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To analyze the diagnostic reliability of various partial-mouth recording systems (PMRS) for the simultaneous assessment of supragingival plaque, calculus, and gingival inflammation in a population of Portuguese adults. Methods: A single examiner determined the levels of plaque, calculus, and gingival inflammation in 108 subjects using quantitative and dichotomous indices. Half-mouth and ≤10-tooth PMRS were compared with full-mouth examination (FME). Results: On comparison with FME, Q1 + Q3, Q1 + Q4, Q2 + Q3, Q2 + Q4 combinations and the Ramfjord teeth did not show statistically significant differences in the simultaneous assessment of plaque, calculus, and gingival inflammation using both quantitative and dichotomous indices. Comparison of the prevalence of subjects that presented discrepancy in the three clinical parameters between FME and PMRS, Q1 + Q3 combination was associated with lower percentages of discrepancy (range of discrepancies = 0.9-6.4 percent) and a higher specificity (≥0.90) and sensitivity (≥0.89). Conclusions: The Q1 + Q3 combination could be particularly applicable in studies investigating relationships between the state of gingival health and environmental or patient-related systemic factors, as well as in the development of oral health scales that include gingival parameters.
Journal of Public Health Dentistry 07/2012; · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: The objective of this study was to investigate if intellectual disability (ID) itself constitutes an absolute contraindication to oral rehabilitation with osseointegrated implants, or if adequately selected patients can benefit from this dental treatment technique. Method: We report a series of eight patients with non-syndromic ID and no associated neuromuscular disorders, craniofacial abnormalities, or serious systemic complications, in whom oral rehabilitation was performed using implant-supported prostheses, with a follow-up of one to three years. Results: A total of 18 titanium implants were inserted and nine implant-supported prostheses were constructed. Follow-up examination showed that although the majority of implants presented a degree of peri-implant mucositis, all were osseointegrated and the prostheses were functional. Conclusions: Although there is very little literature on this subject, the results of this pilot study allow us to suggest that osseointegrated oral implants could constitute a therapeutic option for patients with ID. The success of oral rehabilitation depends fundamentally on appropriate patient selection. [Box: see text].
Disability and Rehabilitation 03/2012; 34(23):2025-30. · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract - Background: Self-inflicted oral injuries of organic origin are particularly common in certain diseases, syndromes, and systemic disorders. In this article, we discuss the characteristics of these oral lesions and their treatment. Literature Search: The authors have reviewed the most relevant literature relating to oral self-injury through a search in textbooks and published articles included in the Medline database for the years 1970-2010, and selected published cases from the last two decades. Results: The majority of the literature on oral self-injury is in the form of case reports. Self-injury is particularly prevalent in patients with Lesch-Nyhan syndrome, a heterogeneous group of neurological disorders, congenital insensitivity to pain with anhidrosis, and mental retardation. It is most common in males in the early years of life, and the sites most frequently involved are the lower lip and the tongue. Therapeutic approaches in these patients have included psychological and pharmacological treatment, intraoral devices, and surgical procedures. Clinical Implications: Intraoral devices are the best therapeutic option for self-injury of organic origin, although this approach is not free of complications. The current lack of standardized treatment protocols for oral self-injury means that therapy must be individualized.
[Show abstract][Hide abstract] ABSTRACT: Since the introduction of bisphosphonates to treat diseases that affect bone remodelling, there has been an increasing number of cases of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ). Epidemiological data regarding BRONJ vary widely between studies, and a number of potential methodological biases have been detected. In some small preliminary studies, single nucleotide polymorphisms associated with an increased risk of BRONJ among cancer patients have been identified. However, genetic susceptibility to oral BP-related BRONJ has not previously been discussed. We suggest that epidemiological variability could be related to the existence of a susceptibility factor particularly prevalent in the population of a well-defined geographical region. To support our hypothesis we performed a search for published case series, only including those with at least 10 patients detected in a single city or a delimited geographical region; this showed that 55% of reports came from Mediterranean countries such as Italy, Israel, Spain and France. The finding does not appear to be conditioned by publication bias. Furthermore, conditions such as classic Kaposi sarcoma and beta-thalassaemia, though not exclusive to the Mediterranean region, also have a high prevalence in that area. We speculate that some of the patients included in the selected US and Australian series may be of Spanish or Italian descent. With an ageing population, the prevalence of osteoporosis will increase, and the number of cases of oral BP-related BRONJ may rise exponentially. Identification of risk groups with susceptibility to BRONJ will arise caution when prescribing BPs and will allow new preventive and therapeutic strategies to be developed.
Medical Hypotheses 12/2011; 78(2):315-8. · 1.18 Impact Factor