Dental Hypotheses
Volume:5 Issue: 2, Apr-Jun 2014

Alveolar osteitis (AO) creates severe and self-limiting pain, which needs to be treated with several postoperative visits, leading to increases in patient''s morbidity and costs. Hence, the most basic and best treatment could be prevention. The aim of this study was to investigate the efficacy of bioadhesive chlorhexidine (CHX) gel in reducing AO occurrence with published studies. Medline/PubMed, Scopus, EBSCO, Ovid and Cochrane central registry for control trial were searched up to 28 February 2014 using «alveolar osteitis» and «chlorhexidine» as key words for systematic review and meta-analysis. Inclusion criteria were prospective and randomized controlled trials (RCTs) published on this topic. From the chosen studies, the eligible articles were reviewed. Data were analyzed using Review Manager 5. 2 software. Out of 43 studies, seven eligible trials with 593 participants were selected. Bioadhesive 0. 2% CHX gel prevented approximately 72% of AO (Odd ratio (OR) = 0. 28, 95% confidence Interval (CI): 0. 18-0. 44; P < 0. 001). Bioadhesive 0. 2% CHX gel may be effective as a post-medication to reduce incidence of AO.

Current theories of dentin bonding are based on the concept of «hybrid layer». However, the histological complexity of dentin, as well as the vulnerability of the hybrid layer, goes against the long-term effect of dentin bonding. At the same time, post-operative sensitivity is more likely to occur after traditional adhesive restoration. The Hypothesis: Compared to dentin bonding, enamel bonding exhibits a more optimal immediate and long-term performance, owing to its higher degree of mineralization, well-arranged enamel crystals and the porous structure after etching. Moreover, «enamel hypersensitivity» is never going to happen due to the lack of tubules existing in dentin. In light of this phenomenon, we brought up the concept and the proposal method to form an «enamel-like» dentin, simulating enamel structure to achieve satisfying durability of dentin bonding and obtain good performance for preventing post-operative sensitivity. With the application of mesoporous silicon bi-directionally binding to hydroxyapatite of dentin itself and hydroxyapatite nanorods synthetized in vitro, we may be able to form an enamel-like «functional layer» via ion-regulating self-assembly. Evaluation of Hypothesis: This paper explains how to achieve dentin enamel-like modification by chemical methods, especially, details the strategies and possible mechanisms of the hypothesis. Validation of the hypothesis is more likely to eliminate the adverse effect of dentinal fluid, improve long-term performance of dentin bonding, offer strategies for desensitizing treatment and self-repairing carious-affected dentin, and furthermore, provide the possibility to introduce new theories of dentin bonding.

This paper summarizes the different conditions, which have a well-known influence on the resorption of tooth roots, exemplified by trauma and orthodontic treatment. The concept of the paper is to summarize and explain symptoms and signs of importance for avoiding resorption during orthodontic treatment. The Hypothesis: The hypothesis in this paper is that three different tissue layers covering the root in the so-called periroot sheet can explain signs and symptoms of importance for avoiding root resorption during orthodontic treatment. These different tissue layers are; outermost - an ectodermal tissue layer (Malassez''s epithelium), a middle layer - composed by the collagen-mesodermal tissue layer, and an innermost root-close innervation layer. Abnormalities in one of these tissue layers are thought to cause inflammatory processes in the periodontal membrane comparable to inflammatory processes provoked by trauma and orthodontic pressure. Inflammatory reactions are followed by resorptive processes in the periroot sheet and along the root surface. Evaluation of the Hypothesis: Different morphologies in the dentition are signs of abnormal epithelium or an abnormal mesodermal layer. It has formerly been demonstrated how demyelinization of the myelin sheaths in the peripheral nerves close to the root provoke resorption. Accordingly, conditions affecting these tissue layers can be associated not only with different morphologies but also with general symptoms and diseases (e.g., ectodermal dysplasia and hypophosphatasia).

The relationship of oral health (OH) with the quality of life (QL) is multidimensional; the extent to which oral disorders disrupt an individual''s normal function may affect health-related QL, particularly among children. The current study aimed to examine the relationship between clinical OH variables, psychological, social, and demographic factors with regard to OH-related QL (OHRQL) in the children of Isfahan province, Iran. Data relevant to the characteristics, psychological, dental, and demographic factors of 336 children aged 11-15 were assessed. These characteristics included sociodemographic data, sense of coherence (SOC), self-esteem, and children''s health locus of control (HLC). The clinical variables that were implicated to be effective on the QL were assessed via an oral examination. The parameters assessed included caries, periodontal disease, malocclusion, and traumatic dental injuries. Finally, the data was analyzed using Statistical Package for the Social Sciences (SPSS) software and P-value was set at 0.05. The results indicate that oral disease, the extent of treatment-need, self-reported symptoms, and degree of dysfunction were influential in QL. Bivariate (Spearman and Pearson) analysis showed that there was a relationship between decayed, missing, and filled teeth (DMFT) and QL score (r = 0.4, P-value = 0.03) and gender and total self-esteem (r = 0.8, P-value = 0.009). Self-esteem and index of orthodontic treatment need (IOTN) (P-value = 0.01), education level of the parents (P-value = 0.03), and overall health (P-value = 0.001) significantly influenced OHRQL. The findings of our study indicate that oral disease, the extent of treatment-need, self-reported symptoms, and degree of dysfunction were influential in the QL.

The study aims to establish an etiological association between diabetes and precancerous lesions of the oral cavity by cytomorphometric analysis of the oral epithelium. Study Design: Smears were obtained from three distinct oral sites - buccal mucosa, dorsum of the tongue and the floor of the mouth in ten controls and ten patients previously diagnosed with type II diabetes. The oral smears were stained with Papanicolaou SA-36 solution. An eye - piece graticule was used to obtain the cytoplasm and nuclear dimension; where larger dimension was denoted as «D» and the smaller dimension was denoted as «d». The nuclear area (NA), nuclear diameter (ND), cytoplasmic area (CA) and the cytoplasmic / nuclear ratio (C/N) were evaluated from 50 cells predominant in each oral site. Statistical Analysis: The cytomorphometric data obtained was compared between the group of diabetic patients and the control groups using the student''s t- test (SPSS version 11. 0). Results showed that the nuclear area and the nuclear diameter of oral epithelial cells were increased in diabetic patients, as compared to non- diabetics, while the non- diabetic patients demonstrated an increase in nuclear ratio. The results from this study suggest that diabetes mellitus can cause alterations in oral epithelial cells that are detectable with exfoliative cytology.

Trauma causes fractures of anterior teeth commonly, where extraction is not considered as a part of treatment plan. This case report presents the endodontic management of a horizontally fractured right central incisor involving healing with granulation tissue, using an intraradicular splinting technique. Case Report: A patient complained of pain and mobility of the upper right front teeth since 1 day. The root canal therapy of the upper central incisor was done. The intraradicular stabilization involved placing a fiber post in the canal and luting with resin cement. This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment. The recent improvements in the dental materials resin-based restorative materials with tooth-colored fiber post are of choice because of several advantages such as esthetics, bonding to tooth structure, and low modulus elasticity similar to that of dentin.

Osseointergration defined as the intimate bone-to-implant apposition is the key to implant success and predictability. The primary bone anchorage has long been considered as the gold standard factor and buzzword for successful osseointergration. Bone augmentation and simultaneous implant surgery procedure allow clinicians to reconstruct alveolar bone deficiencies, preserve alveolar dimensions, and replace missing teeth with dental implants in a prosthetically driven position with natural appearance and function. Case Report: This paper reports a case where primary stability although compromised during initial placement, the use of bone graft with platelet-rich fibrin (PRF) combined with stringent maintenance and elimination of micromovements leads to a successful outcome. Six months postoperative findings showed a stable implant with good soft and hard tissue augmentation. Primary stability though considered to be a gold standard factor in implant success is not a sole requisite. Achieving secondary stability is the long-term goal, and a combination of stringent maintenance and minimal micromovements will make it achievable.

Atypical odontalgia (AO) is a subgroup of persistent idiopathic facial pain. We introduced a combination therapy of fluoxetine and clonazepam to treat AO. Case Report: A 30-year-old female with the chief complaint of severe pain (#8 based on Visual Analogue Scale(VAS)) in the site of extracted tooth #3 since 2 months ago was referred to the Department of Oral Medicine. The pain was of sharp quality continuing all day long and radiated to cervical muscles, forehead, and mandible of the ipsilateral side and contra lateral structures. The patient was treated with fluoxetine 20 mg/d and clonazepam 0.5 mg/d. The pain intensity was reported almost #0 when the patient was re evaluated 1 month after the first visit. An 8-month follow up revealed no sign of pain and discomfort on the affected site. Combination therapy with clonazepam and fluoxetine has a positive effect in the treatment of AO.