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no difference related to jaw location. Fractured teeth weremore likely to be associated with endodontic treatment,and most of the cracks occurred in restored teeth. Teeth re-stored with amalgam and gold inlays were more likely tocrack than teeth restored with resin and porcelain inlays.
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Clinical Significance.—Dentists may have touse several examination methods to detectcracked teeth, although the bite test is the bestmethod for reproducing symptoms. Althoughit is not clear how cracks form in restored teeth,
Dental Abstracts
nonbonded restorations and the sharp internalline angle associated with amalgam and gold re-tention may contribute.
Seo D-G, Yi Y-A, Shin S-J, et al: Analysis of factors associated withcracked teeth. J Endod 38:288-292, 2012
Reprints available from J-W Park, Dept. of Conservative Dentistry,College of Dentistry, Yonsei Univ., Gangnam Severance Hosp.146-92 Dogok-dong, Gangnam-gu, Seoul 135-720, Republic ofKorea; e-mail: [email protected]
Dental MaterialsRetention of pit and fissure sealants
Background.—Since the 1980s studies have been con-ducted on the efficacy of pit and fissure sealants, notingthe clinical longevity of various sealing materials. Retentionrates are classified as intact sealant, partial loss ofmaterial,or complete loss of material. Optimum protection only oc-curs if there is a complete seal of all the pits and fissures, sothe clinical adequacy of sealing materials and/or applicationtechniques is only relevant with the intact sealant category.A meta-analysis was conducted to determine which mate-rials provide the best retention rates so that evidence-based recommendations can be made for clinical practice.
Methods.—The MEDLINE, EMBASE, and CENTRAL da-tabases were searched, eventually identifying 98 clinicalreports and 12 field trials reports for analysis. The materialsstudied included ultraviolet (UV) light-, light-, and auto-polymerizing resin-based sealants; fluoride-releasing mate-rials; compomers; flowable composites; and glass-ionomercement-based sealants.
Results.—The clinical reports found an average reten-tion rate of 60.0% after 2 years and 33% after 3 years forthe UV light-polymerizing resin-based sealants. Their reten-tion rates after 2, 3, and 5 years via meta-analysis were51.1%, 38.6%, and 19.3%, respectively.
Clinical reports found that 79.3% of auto-polymerizingresin-based sealants were intact after 2 years and 69.6% after5 years. Meta-analysis revealed 2- and 5-year retention ratesof 84.0% and 64.7%, respectively.
For the light-polymerizing resin-based sealants, 77.8%were intact after 2 years and 73.3% after 5 years. Retentionrates were 77.8% at 2 years, 80.4% at 3 years, and 83.8% after
5 years based on meta-analysis data. Although the numberof intact sealants in the field trials after 2 years was lessthan in the clinical trials, the retention rates for the fieldtrials were higher than the clinical trials after 3–5 years.
Fluoride-releasing resin-based sealants demonstratedintact seals in 79.1% of cases after 2 years and 86.5% after5 years. The meta-analysis revealed 2-, 3-, and 5-year reten-tion rates of 81.1%, 75.3%, and 69.9%, respectively.
Few studies focused on flowable composites used assealants. Three clinical trials demonstrated intact sealantsin 78.1% of cases after 2 years, but there were insufficientdata to be included in a meta-analysis.
Compomers demonstrated intact sealants after 2 and 6years of 36.1% and 3.5%, respectively. Meta-analysis showedretention rates of 52.0% after 2 years and 17.9% after6 years.
After 2 years, just 15.6% of the glass-ionomer cement-based sealants remained intact. This fell to 7.0% after3 years. Meta-analysis revealed retention rates of 12.3% at2 years, 8.8% at 3 years, and 5.2% at 5 years.
Resin-based sealant materials placed by means of enamelbonding had the best retention behavior. Ranked by 5-yearretention rate, the best materials were light-polymerizingresin-based sealants (83.8%), fluoride-releasing resin-basedsealants (69.9%), and auto-polymerizing sealants (64.7%).The 5-year retention rates for glass-ionomer cement-basedsealants, compomers, and UV light-polymerizing materialswere the lowest—less than 19.3%.Thenumberof completelyretained sealants falls with increasing time.
Discussion.—Good retention rates after 5 years werefound for visible-light sealants, fluoride-releasing materials,and auto-polymerizing sealants. The results with UV light-polymerizing materials, compomers, and glass-ionomercement-based sealants were inferior.
Clinical Significance.—Resin-based sealants(light- and auto-polymerizing sealants as well asfluoride-releasing materials) are appropriatefor use in clinical situations. Because light-polymerizing sealants have superior longevityand are less error-prone, they have a slight ad-vantage for use in daily dental practice. Flowablecomposites are more suitable for applications inminimally invasive filling situations, but lack ev-idence from long-term studies to be included in
this meta-analysis. Glass-ionomer cement-basedsealants had the lowest retention rate, perhapsbecause of a lack of adhesive bonding withenamel.Thesematerials, alongwithcompomers,are not recommended for routine clinical use.
K€uhnisch J, Mannsmann U, Heinrich-Weltzien R, et al: Longevity ofmaterials for pit and fissure sealing—results from a meta-analysis.Dent Mater 28:298-303, 2012
Reprints available from J K€uhnisch, Ludwig-Maximilians-Universit€at M€unchen, Poliklinik f€ur Zahnerhaltung und Parodonto-logie, Goethestraße 70, 80336 M€unchen, Germany; fax: þ49 895160 9349/9349; e-mail: [email protected]
Eating DisordersOral health in eating disorder patients
Background.—Eating disorders (EDs) can be dividedinto three main diagnoses: anorexia nervosa (AN), charac-terized mainly by underweight and food restriction; bulimianervosa (BN), characterized by binge eating and inappro-priate compensatory behaviors; and eating disorder nototherwise specified (EDNOS), which is a heterogenousmix of AN- and BN-like atypical EDs. The onset, expression,and intensity of EDs vary over time and between individ-uals. The early detection of EDs is important with respectto outcome, affecting psychological and somatic complica-tions and oral health consequences. A knowledgeable andinformed dental professional can assist in the secondaryprevention of EDs, but often dental personnel prefer notto pursue suspicions of EDs, possibly because of fear of los-ing the patient or lack of confidence in their suspicion. Pa-tients with EDs often avoid health care professionals orconceal the source of their problems because of guilt,shame, or possibly self-denial of the disease. A study was un-dertaken to examine the oral health status and prevalenceof self-reported symptoms in patients with EDs receivingtreatment in an outpatient specialist clinic.
Methods.—Fifty-four patients were matched with con-trols, all of whom completed a questionnaire and under-went dental clinical examinations. The responses andfindings of the two groups were compared.
Results.—Mean age at onset of ED was 16 years;mean duration of the disease was 4.4 years. Twenty-five
patients reported inducing vomiting, and 31 reportedbinge eating. Mean BMI was 14.9 for AN patients (22.8for their controls), 21.8 for BN patients (24.4 for theircontrols), and 20.3 for EDNOS patients (23.1 for theircontrols).
ED patients perceived their oral health to be worse thancontrols did. Several self-reported oral symptoms weremore common in ED patients than in controls. These in-cluded mouth dryness, burning tongue, tongue thrustingat night, nausea, facial pain, and lump in the throat. TheED group had more severe dental erosion than controls,and this erosion extended into dentin or close to dentinalexposure over large surfaces and on one tooth or more.With longer duration of the disease ED patients were signif-icantly more likely to have dental erosion. Self-reported im-paired oral health was significantly correlated with highergingival bleeding index; decayed, missing, or filled surface(DMFS) counts; and decayed, missing, or filled tooth(DMFT) counts.
Considering dental problems and burning mouth asself-reported predictors of ED resulted in a sensitivity andspecificity of 80% and 52%, respectively. Considering dry/cracked lips, dental erosion, and gingival bleeding indexas clinical predictors of ED produced a sensitivity and spec-ificity of 76% and 79%, respectively. Using both sets of signs/symptoms to predict ED produced a sensitivity of 83% anda specificity of 79%.
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