Quintessence International, 09/2001

Elevated blood pressure appears to be an affliction that is more common in developed than in developing countries. However, the blood pressure consistently increases with age in most populations in the world, modified only by genetic and environmental factors. In the United States, it is estimated that there may be as many as 58 million people with hypertension; fewer than 5% of these cases have a curable cause. Oral health care providers can expect to be called on to care for patients with this progressively debilitating disease. To provide competent care to patients with hypertension, clinicians must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.

Objective: A study of the prevalence of hypertension in the patient population was conducted at the University of Mississippi, School of Dentistry. Method and materials: The 3,665 records reviewed represented patients treated by undergraduate dental students from 1993 through 1997. Inclusion criteria were diagnosis of hypertension by a physician or presentation with a systolic reading of greater than 140 mm Hg or a diastolic reading of greater than 90 mm Hg. Results: Of the 1,021 subjects who met the criteria, 609 were previously diagnosed with hypertension and 412 exhibited elevated blood pressure. The prevalence of diagnosed hypertension in the study population was 16.6%. When the 412 subjects who exhibited elevated blood pressure were included, the prevalence of hypertension was 27.9%. At the initial screening, 32.2% of diagnosed adults and 27.0% of undiagnosed adults exhibited a systolic reading of 160 mm Hg or greater or a diastolic reading of 100 mm Hg or greater. For all age groups, there were no statistically significant differences in race, sex, educational level, or occupation between the diagnosed and undiagnosed groups. Conclusion: The prevalence of hypertension, often undiagnosed or uncontrolled, justifies routine blood pressure screening of dental patients.

Mercury-containing amalgam restorative material has come under attack for its alleged harmful effects on systemic health. A literature search revealed that amalgam restorations release small quantities of mercury but apparently not enough to cause systemic health problems. Mercury from dental amalgam restorations cannot be linked to kidney damage, Alzheimer's disease, multiple sclerosis, other central nervous system diseases, amalgam disease, mental disorders, damage to the immune system, increases in antibiotic resistance, or harmful reproductive effects. Dentists occupationally exposed to mercury have not been shown to suffer harmful reproductive or other systemic health effects, provided proper mercury hygiene is used. There are legitimate health concerns about alternative restorative materials, including resin composite. According to the latest scientific information available, dental amalgam remains a safe and effective restorative material.

Objective: The purpose of the present study was to compare ethylenediaminetetraacetic acid conditioning and phosphoric acid conditioning of dentin in combination with two principally different commercial dentin bonding systems. Method and materials: Twenty-one extracted human third molars were used. All teeth were caries free, and no teeth were root filled. In total, 29 pairs of dentin surfaces were obtained from 21 teeth. One dentin surface in each pair was etched with a 32% phosphoric acid gel for 15 seconds, and the opposite surface was etched with a 24% ethylenediaminetetraacetic acid gel for 3 minutes. One experimental group of 15 dentin surface pairs was subsequently bonded with All-Bond 2, a two-component system, and the other group of 14 pairs was bonded with Prime & Bond NT, a one-bottle adhesive. A flowable resin composite was inserted in the experimental cavity and light cured. Shear bond strength testing was performed according to the protocol of the International Organization for Standardization. Results: The combination of conditioning with ethylenediaminetetraacetic acid and bonding with All-Bond 2 was significantly better than all other combinations, providing a shear bond strength that was 61% to 123% greater. Conclusion: Use of ethylenediaminetetraacetic acid in combination with All-Bond 2 resulted in a significantly greater bond strength to dentin than did conventional acid etching.

The infectious disease dental caries results in lesions that may affect enamel, dentin, pulp, and cementum. If a caries lesion has progressed to the stage at which it requires restorative intervention, it is important that the clinician understand the tissue changes in the dentin that are likely to have taken place during lesion development. Until the present, no major distinction between the restorative treatment of active (rapidly progressing) and arrested (slowly progressing) lesions has been made, despite the fact that the two conditions exhibit major differences in tissue changes in the pulp-dentin complex. Intratubular changes and tertiary dentin formation will affect the outcome of the restorative treatment. In unaffected dentin and in rapidly progressing lesions, permeable tubules persist, and when the preparation of carious teeth results in the opening of unaffected dentin, greater care must be taken in all phases of the restorative procedures than if the dentin is impermeable. An active, deep lesion can be changed to an arrested lesion by a two-step excavation approach. Optimal assessment of the prevailing clinical conditions can only be made on the basis of thorough knowledge of the biology of the pulp-dentin organ.

Objective: The aim of the study was to evaluate the clinicopathologic features of 54 paradental cysts. Method and materials: The cases were retrieved from the files of the Department of Oral Pathology of the University of São Paulo, in Brazil. Only case files that included complete data, radiographs, and clinical history were used for the study. Results: Most of the cysts were adjacent to a partially erupted mandibular third molar; only two cysts were adjacent to mandibular second molars, and one cyst was adjacent to a first molar. Women were affected more often than were men (33:21), and most of the patients were in their second or third decades. In most cases, the affected tooth had a history of one or more episodes of pericoronitis. Histologically, these cysts presented the typical features of an inflammatory cyst, having a lining epithelium, which apparently resulted from a union between reduced enamel epithelium and oral epithelium. Conclusion: Development of the paradental cyst could be avoided if episodes of pericoronitis were properly treated, because the cyst is usually related to pericoronitis.

Ectodermal dysplasia is both physically and emotionally devastating to patients. With proper restorative intervention, the quality of life can be improved for patients with ectodermal dysplasia. This case report outlines a method of restoring function and esthetics for a 14-year-old boy with ectodermal dysplasia. It is important that these patients be treated at an early age to aid in their social interactions.