Background Anxiety experienced by individuals visiting the dental office to receive treatment is prevalent in the population. The clinical manifestation of these anxieties is considerable; it is estimated that approximately between 14 and 30 million people in the United States do not seek routine dental care due to dental anxiety. Dentists and other scientists have explored many techniques and procedures in attempts to ameliorate these anxieties and improve patient care. Biofeedback is a process that involves measuring a person's specific bodily functions such as blood pressure, heart rate, skin temperature, muscle tension, or breathing rate, and conveying the information to the patient in real-time. This raises the patient's awareness and therefore the possibility of conscious control of those functions. Evidence has shown biofeedback to be a useful modality of treatment for numerous conditions associated with anxiety. Anxiety has been shown to up-regulate the sympathetic nervous system. When the sympathetic nervous system is up-regulated, the pain threshold is decreased, and physiologic parameters of anxiety are manifested in the patient. This physiological phenomenon is well understood and demonstrates that, with anxiety, the individual will have a decreased pain threshold (i.e., greater response to noxious or painful stimuli). The purpose of the current pilot study is to investigate the use of a novel biofeedback system (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and subsequently the pain associated with dental injections. Methods Eighty-one subjects participated in this randomized controlled study. Forty subjects were in the experimental group and forty-one subjects were in the control group. All subjects were asked to fill out a pre-injection survey (Dental Injection Sensitivity Survey - DISS), measuring baseline anxiety levels. Subjects in the experimental group used a biofeedback technique, while subjects in the control group were not exposed to any biofeedback. All participants then received an inferior alveolar local anesthetic injection. Subjects in both groups were then given a post-injection survey (measuring anxiety levels), and filled out a Visual Analog Scale (VAS). The VAS was designed to measure the subjects' perception of pain of the injection, the overall injection experience, and anticipatory anxiety for future injections. Results The results of the study demonstrated that there was no significant difference between the treatment group and the control group with respect to any of the pre/post-operative anxiety measures as recorded by the DISS. This study did demonstrate that with the use of the RESPeRATE™ device there was a significant difference in the overall injection experience between the experimental group and the control group (p=0.013), as measured by the VAS. A trend towards improved responses for the experimental group was noted with respect to both level of discomfort and ratings of future nervousness; these results did not reach a statically significance of p<.05. Conclusions Future studies and power calculation will be more specific towards the RESPeRATE™ in a dental setting, and lead to more accurate approximations on the number of subjects needed to determine whether the difference was due to chance or due to the treatment modality. It appears that this novel pilot study was underpowered. It would also be feasible to apply the technology to other areas in dentistry where anxiety and sympathetic up-regulation are etiologic components. Areas of future studies may include temporomandibular joint dysfunction, orofacial pain, periodontal disease, and wound healing.

Approximately 26% of the U.S. population between the ages of 65 and 74 years are completely edentulous. Of the different proposed predictors and risk factors, low income and education levels have the highest correlation with tooth loss. While the incidence of complete edentulism in the United States has progressively declined over the past decade, the continued growth of the population strongly suggests that edentulism prevalence will likely remain constant or increase over the next few decades. In patients wearing complete prosthetic appliances, several post-treatment complications may arise, including denture associated Candida species infections and mucosal stomatitis. These type of fungal infections are associated with patient-reported symptoms (e.g. pain or discomfort) and may impede normal oral function. In this study the activity of 11 (antimicrobial and/or antifungal) agents in a dental adhesive carrier against two strains of C. albicans was assessed. In conventional minimal inhibitory concentration (MIC) assays, C. albicans were resistant to histatin 5 and lactoferricin B, yet very susceptible to SMAP28; susceptible to long chain bases sphingosine, dihydrosphingosine, and phytosphingosine; and susceptible to anti-fungal agents amphotericin B, chlorhexidine dihydrochloride, chlorhexidine gluconate, fluconazole, and nystatin. However, in 1% dental adhesive (final concentration) C. albicans were resistant to histatin 5, lactoferricin B, SMAP28, sphingosine, dihydrosphingosine, and phytosphingosine suggesting that the components in denture adhesive may inactivate local innate immune factors in the oral cavity possibly predisposing users to fungal infections in relation to their dental prostheses. In MIC assays in 1% dental adhesive (final concentration) C. albicans were susceptible (p value < 0.05) to amphotericin B, chlorhexidine, dihydrochloride, chlorhexidine gluconate, fluconazole, and nystatin strongly suggesting that these anti-fungal agents could be candidates for inclusion in denture adhesive formulations, and also be used as a prescribed topical treatment in individuals with fungal infections of the oral mucosa.

Dental Caries is still considered one of the most prevalent chronic diseases that affect children in the US. Access to oral care problems could be due to the limited availability of services or unwillingness of people to seek services. As a proposed solution to those challenges, Atraumatic Restorative Technique (ART) was developed in the 1980s as an affordable, patient friendly caries management procedure that does not need extensive operator training or special skills. ART was originally developed to be conducted in field settings; however, after initial evidence of effectiveness, the World Health Organization (WHO) and the International Dental Federation (FDI) promoted the use of ART in modern clinical settings worldwide. In the US, the practice of ART is not believed to be widely used. This may be a result of little attention given to (ART) in dental education and advanced training. This dissertation is comprised of three separate studies that investigated the extent and the factors related to the didactic and clinical instruction on ART in US pre- and post-doctoral pediatric dentistry programs and the factors related to the willingness of pediatric dentists to use ART with their child patients. survey post-doctoral pediatric dentistry program directors and pre-doctoral pediatric dentistry program directors. In study III a different instrument was used to survey pediatric dentists in the US. The survey instruments were tested for content and face validity by cognitive analysis interviews and pilot testing. Using web-based survey methodology, two questionnaires were sent out in May 2010 to investigate self-reported use of ART in educational training institutes (study I and II) and in April 2011, a third questionnaire was sent to a random national sample of pediatric dentists (study III). Using a conjoint design, the third questionnaire asked pediatric dentists to rate their willingness to use ART for 9 patients' scenarios. Eighty eight percent of Pediatric Dentistry Residency programs and 66 % of pre-doctoral pediatric dentistry programs in the US provided clinical training on ART; however only 30% of post-doctoral programs and 14 % of pre-doctoral programs used ART "Very Often/ Often" as a caries management technique for their pediatric patients. Pediatric Dentistry residency programs and pre-doctoral pediatric dentistry programs used ART mainly in primary, anterior, single surface cavities and as an interim treatment. Attitudes toward ART alone and after controlling for other variables explained 35% of the level of training on ART in post- doctoral program and 23% in pre-doctoral pediatric dentistry programs. For study III, conjoint analysis showed that being very young and/or uncooperative were the most important reasons practitioners reported a higher likelihood of using ART. Although insurance coverage was the least important factor overall, not having any insurance was identified as an additional important factor in decisions to use ART. Collectively, our results suggest that that the use of ART is not widespread in the US. In addition, ART is viewed by some as a sub optimum treatment and needs to be modified to conform to the US standards of care. On the other hand, educators and pediatric dentists who had positive views of ART thought it could be a valuable treatment for very young, uncooperative children and children with no insurance.

There are no previous studies validating the accuracy and repeatability of ClearMatch photographic shade analysis system. The purpose of this study was to compare the shade matches performed by a photographic shade analysis system (ClearMatch) with conventional visual shade matching method under simulated clinical conditions. Three shade matching methods were used to match twelve shade tabs under simulated clinical conditions using a Vita Classical shade guide: conventional visual shade matching using 3 human raters (VM – Visual method), photographic shade analysis system (CM - ClearMatch) using two different ways of normalizing the image (CM-A2 and CM-ref respectively). Shade matching for all methods was completed at two separate sessions. The Kappa statistic was used to determine the intra-rater and inter-rater agreement. CIELAB values of the shade results were used to produce scatter plots as well as to calculate the color difference (delta E) between VM and CM groups. There was no inter-rater agreement between VM and CM-A2 (k=0.000 and k=0.015 for the first and second sessions respectively) while VM and CM-ref showed weak agreement (k=0.244 and k=0.091 respectively). Intra-rater agreement was strong in all groups VM, CM-A2 and CM-ref (0.705, 0.803 and 0.681 respectively). CM-A2 had 2 (8.3%) shade matches with a delta E of less than 2.6 (clinically imperceptible), while CM-ref had 12 (50.0%) imperceptible matches. CM-A2 had an additional 16 (66.6%) shade matches with delta E of less than 5.5 (clinically acceptable), while CM-ref had 23 (95.8%) additional acceptable matches. There was poor agreement in exact shade matches between conventional visual shade matching method and the photographic shade analysis system. The repeatability of the photographic shade analysis system was shown to be comparable to conventional visual shade matching. Using conventional shade matching as the gold standard, the capability of this photographic shade analysis system to accurately shade match has not been achieved.

Statement of Problem There are limited studies evaluating the effect of a cyclic load on interim fixed prosthetic materials and its effect on flexural strength. Purpose of Study 1) To verify the flexural strength of previously studied interim fixed prosthetic materials. 2) To establish the flexural strength of new, advanced generation and untested interim fixed prosthetic materials. 3) To determine the effect of cyclic load on the flexural strength of interim fixed prosthetic materials. Materials and Methods Bar-type specimens of Caulk Temporary Bridge Resin, VitaVM CC, Protemp 3 Garant and Radica were fabricated according to International Standards Organization 4049 and American National Standards Institute/American Dental Association specification 27. After being stored in distilled water for 10 days, specimens were divided into Noncycled and Cycled Groups. The Noncycled Group specimens were fractured under a 3-point loading in a Bose Electroforce 3300 testing instrument at a crosshead speed of 0.75 mm/min. Cycled Groups specimens underwent a 6-12 Newton 3 Hertz cyclic load for 20,000 cycles in a Bose Electroforce 3300 testing instrument. Immediately following completion of the cycles, the specimens were fractured under a 3-point loading. Maximal loads to fracture in Newtons were recorded and mean flexural strengths were calculated (n = 20 per group). Comparisons were made with analysis of variance and Tukey's Multiple Comparison Test. Results Noncycled (NC) and Cycled (C) groups order of mean flexural strengths (MPa) from lowest to highest mean were as follows: Caulk (Noncycled - 53.83; C - 60.02), Vita VM CC (NC - 65.96; C - 66.83), Protemp 3 Garant (NC - 75.85; C - 77.18), and Radica (NC - 106.1; C - 115.96). In the Noncycled and Cycled groups, Radica was statistically superior when compared to all materials and Protemp 3 Garant was statistically superior to Caulk Temporary Bridge Resin. There was no statistically significant difference between the material's flexural strengths before and after cycles. Conclusion Within the limitations of this study, 20,000 cyclic loads of 6-12 Newtons at 3 Hertz did not have a significant effect on the flexural strength of interim fixed prosthetic materials. Radica demonstrated significantly superior flexural strength over other materials tested.

The objective of this study was to retrospectively evaluate the prevalence of perineural invasion in cases of mucoepidermoid carcinoma (MEC). The study will determine if previously assessed perineural invasion by original pathology reports would be increased by re-review of the originally hematoxylin-eosin-(H &E) stained slides as well as review of slides reacted immunohistochemically with S100 to enhance visualization of nerves. The study will also assess whether perineural invasion or its absence in MEC is associated with clinical outcome. Thirty-one cases of major and minor salivary gland MEC were reviewed for perineural invasion and compared to the perineural invasion status stated on the original pathology report when available (13/31). All H & E-stained slides were reviewed as well as S100-reacted sections of each case’s tissue blocks that contained tumor. Patient demographics and clinical outcome were collected from electronic medical records. Perineural invasion was identified in 23% (3/13) of tumors in the original reports, 13% (4/31) of the authors' re-review of the same slides, and 29% (9/31) when cases were reacted with S100. A positive relationship was seen between the discovery of perineural invasion on H & E-stained slides and a greater number of foci of perineural invasion. Perineural invasion and larger-diameter nerve involvement was significantly associated with death at 5-year follow-up. In conclusion, immunohistochemical enhancement improves the accuracy, ease and speed of perineural invasion determination. Perineural invasion is a significant factor in the decreased survival outcome of cases of MEC. These findings support continued inclusion of the presence or absence of perineural invasion as a grading parameter in MEC.

No description available.

Introduction: Root resorption is an undesired but frequent side effect of orthodontic treatment. Several studies have already aimed to evaluate the performance of CBCT on this topic. However, none have addressed the peculiarities of the most common daily orthodontic scenario. The aim of the study was to evaluate the influence of CBCT scans on the diagnosis of artificial external root resorption in the apical third of anterior teeth. Materials and methods: One hundred extracted human anterior teeth were randomly assigned to 2 uneven groups (51 as the control and 49 as the experimental group). A limited area of the apical third of the root of the teeth of the experimental group was selected and a buffer solution was used to induce tooth subsurface demineralization. Before CBCT image acquisition, each tooth was coated with an approximately 0.3 mm thick layer of utility wax to simulate the radiographic appearance of the periodontal space and placed into an empty mandibular anterior socket of a partially edentulous dry human mandible. The mandible was placed into a polystyrene box filled with water prior to the CBCT examination to simulate soft-tissue attenuation and scattering. The CBCT images were obtained on an i-CAT unit (i-CAT Next Generation, Imaging Sciences International, Hatfield, PA) according to three protocols: (I) half scan (180°), 0.40 mm voxel size; (II) full scan (360°), 0.40 mm voxel size; and (III) full scan (360°), 0.125 mm voxel size. The 300 resultant CBCT DICOM volumes were imported into InVivo software (InVivo5, Anatomage, San Jose, CA) for evaluation by three blinded, previously calibrated observers using a five-point confidence rating scale. Cohen’s kappa was used to calculate observers’ agreement. The diagnostic values of sensitivity (Sn), specificity (Sp) and accuracy (Ac) were performed by pooling observer responses for every image modality. Receiver operating characteristic (ROC) were built and the areas under the curve (AUC) were calculated. The Sn, Sp and Ac values were compared by Cochran’s Q test. The AUC values were compared by Mann-Whitney U test. Results: The observers’ agreement ranged from 0.63 to 0.71, which was interpreted as a substantial agreement. Protocol III (0.125 mm voxel size) displayed the highest Sn (81.63 %), Ac (80.67%) and AUC (0.807). There were statistically significant differences between protocol III and the other two protocols (p < 0.001). The specificity of protocol I (84.97 %) was greater than that of protocols II (69.93 %) and III (79.74 %); however statistically significant difference was only found between protocols I and II (p = 0.005). Conclusion: Although there was no difference in accuracy between the degrees of rotation (half and full scan) within the same voxel size (0.4 mm), there was a considerable difference between those and the smallest voxel size (0.125 mm). In fact, it may be suggested that a more dedicated, high resolution scan should be acquired when one intends to investigate the early stage of external root resorption during orthodontic treatment.

E-cigarette (e-cig) use is rising, but much is unknown about the effects of its vapor. This vapor contains chemicals such as propylene glycol, a known antimicrobial, and nicotine, whose derivatives are carcinogenic. Here, we study the effects of vaping on resident bacteria of the oral cavity and on oral cell inflammation. Oral streptococci are major residents in the oral cavity, with S. mutans the primary cause of dental caries. Growth and biofilm formation have been shown to be enhanced upon exposure to traditional cigarette smoke in vitro. In this study, we analyzed the effects of e-cig vapor on growth and biofilm formation in S. mutans, S. sanguinis, and S. gordonii. Organisms and oral epithelial cells were treated using nicotine-free and 3mg nicotine vapor, as well as double-shot menthol freeze flavored 3mg nicotine vapor in a vape chamber designed to phenocopy physiologically relevant exposure. Nicotine-independent inhibition of growth occurred upon exposure in all three bacterial species. Interestingly, biofilm formation was enhanced in the S. mutans while decreased in S. sanguinis and S. gordonii. Epithelial cells showed activation of survival pathways by Western Blot upon exposure to only e-cigarette vapor as well as co-culturing of bacterial and oral epithelial cells at a multiplicity of infection of one The pioneer colonizers S. gordonii and S. sanguinis generally antagonize caries-causing S. mutans, which can become a predominant member of the community under appropriate conditions, leading to dental caries formation. The observed decrease in the biofilm formation of the commensals S. sanguinis and S. gordonii upon e-cig vapor exposure indicates the opportunistic colonization of S. mutans, whose biofilm-forming abilities increased. Following e-cig usage, dental caries and cancer in the oral epithelium may result from this dysbiosis of the microbiome.

The objective of this study was to evaluate the biofilm removal efficacy of three root canal treatment systems: ProUltra® PiezoFlow™, traditional needle irrigation, and the GentleWave® system in an ex-vivo benchtop study. Twenty-four extracted maxillary and mandibular molars were selected. Teeth were all instrumented to a master apical file size #25 with 4% taper. Teeth were then randomly divided into four experimental groups and two control groups. The root canals were inoculated with a culture of Enterococcus faecalis and incubated for five weeks to form a biofilm. Each group was then treated with one of the different root canal treatment systems using 6% sodium hypochlorite (NaOCl) as per the respective manufacturer’s recommendation followed by a rinse with water. Following treatment, teeth were decoronated and roots were sectioned longitudinally. Three scanning electron microscope images were taken at the apical level per root half at 5000x magnification. Images were scored by four calibrated examiners blind to group membership using a four-point scoring system (<5% coverage, 5-33%, 34-66%, and >66%). Results were analyzed using mixed model ANOVA. All the experimental groups were significantly better than the positive control group in removing biofilm. Among the experimental groups, the GentleWave® 15/04 group was significantly better than the other groups. There was no significant difference between the GentleWave® and the ProUltra® PiezoFlow™. Traditional needle irrigation scored the worst in reducing E. faecalis biofilm. The GentleWave™ system was as effective at intracanal biofilm removal as the ProUltra® PiezoFlow™ and better than traditional needle irrigation using 6% NaOCl as an irrigant.