Faculty Bibliography

OBJECTIVE:This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults. MATERIALS AND METHODS/METHODS:Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires. We examined associations between baseline characteristics and (1) the presence of any root caries using Mantel-Haenszel hypothesis tests and odds ratio (OR) estimators and (2) the number of root surfaces with caries among study participants with exposed root surfaces (n = 349) using Mantel-Haenszel mean score tests and Mann-Whitney estimators. RESULTS/CONCLUSIONS/CONCLUSIONS:Adjusting for study site and age, male gender [OR, 1.72; 95% confidence interval (CI), 1.08, 2.78], white race (OR, 2.39; 95% CI, 1.43, 3.98), recent dental visit (OR, 1.98; 95% CI, 1.07, 3.66), poor self-described oral health (OR, 2.65; 95% CI, 1.10, 6.39), and recent professional fluoride treatment (OR, 1.85; 95% CI, 1.06, 3.25) were significantly associated with increased odds to have any root caries, and study participants with exposed root surfaces characterized by male gender [Mann-Whitney probability estimate (MW) = 0.57; 95% CI, 0.51, 0.63), white race (MW, 0.61; 0.55, 0.68), recent dental visit (MW, 0.58; 0.50, 0.67), poor self-described oral health (MW, 0.61; 0.53, 0.69), and flossing at least once per day (MW, 0.57; 95% CI, 0.51, 0.62) were significantly more likely to have a greater number of root surfaces with caries than a randomly selected study participant from their respective complementary subgroups (female gender, non-white, etc.). CLINICAL RELEVANCE/CONCLUSIONS:Our findings may help identify individuals at higher root caries risk.

STATEMENT OF THE PROBLEM/BACKGROUND:  The long-term patient satisfaction and safety of nightguard vital bleaching (NGVB) requires further evaluation. PURPOSE OF THE STUDY/OBJECTIVE:  The purpose of this study was to evaluate patients' satisfaction and identify side effects of NGVB up to 17 years post-treatment. MATERIALS AND METHODS/METHODS:  Thirty-one participants who had completed previous NGVB studies using 10% carbamide peroxide were contacted at least 10 years post-treatment (range 10-17 years, average 12.3 years). Participants reported shade satisfaction (very satisfied [VS], partially satisfied [PS], or not satisfied [NS]) as well as potential complications. Participants had teeth # 6 to 11 examined for tooth vitality, gingival inflammation (Löe's Gingival Index [GI]), and radiographically for external cervical resorption (ECR). RESULTS:  All of the participants had successful lightening of their teeth. Sixty-one percent (19) had not retreated their teeth. Of those who had not retreated their teeth and who responded to the question of whitening satisfaction, 31% (4/13) were VS, 54% (7/13) were PS, and 15% (2/13) were NS with their current shade. Of those who had retreated their teeth, all were VS or PS. Ninety-one percent of the examined teeth had GI = 0 (normal), 7% had GI = 1 (mild inflammation), and 2% had GI = 2 (moderate inflammation). Sixty-nine percent of teeth tested responded to a cold stimulus. Radiographs did not detect ECR or apical lesions. No participant reported having a gingival biopsy post-treatment, and 87% would whiten again. CONCLUSIONS:  Patient satisfaction with NGVB may last as long as 12.3 years in average (range 10-17 years) post-treatment. GI and ECR findings were considered within the normal expectations for the sample studied, suggesting minimal clinical post-NGVB side effects up to 17 years. CLINICAL SIGNIFICANCE/CONCLUSIONS:Nightguard vital bleaching provides patient satisfaction with minimal side effects up to 17 years post-treatment.

PURPOSE/OBJECTIVE:1. To evaluate the effect of tooth age on the microtensile bond strengths (µTBS) of various adhesive systems to dentin; 2. To evaluate the effect of different etching times on the microtensile bond strengths of different adhesive systems to young vs mature dentin. MATERIALS AND METHODS/METHODS:One hundred twenty intact human teeth were mechanically ground to expose midcoronal dentin and were randomly assigned to three groups (n = 40) according to subjects' age in years: 15 to 25, 35 to 45, and >= 55. Within each group, specimens were further randomized into 8 subgroups according to adhesive (etch-and-rinse 3- and 2-step; self-etching 2- and 1-step) and etching time (manufacturer instructions vs extended). Resin composite was applied to the treated surfaces, and after 24 h, all specimens were processed for microtensile bond strength testing. Data were analyzed by factorial ANOVA and Tukey's test (p = 0.05). RESULTS:µTBS values ranged from 10.9 MPa (2-step self-etching, extended etching time, age group 15 to 25) to 50.7 MPa (1-step self-etching, extended etching time, age group >= 55). With only one exception, tooth age and etching time had no significant effect on the bond strengths of the adhesives to dentin. The 2-step self-etching system had lower bond strengths than the other systems, regardless of etching time or tooth age. CONCLUSION/CONCLUSIONS:Tooth age and etching time did not affect the dentin bond strengths of the adhesives tested.

Regular readers will note that we depart from our normal Critical Appraisal format in this issue of the Journal. This particular Critical Appraisal resembles an expanded Contemporary Issues feature and describes a protocol for partial caries excavation that was recently implemented in the student clinics of the University of North Carolina (UNC) School of Dentistry.