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1.  Analysis of salivary fluid and chemosensory functions in patients treated for primary malignant brain tumors 
Clinical oral investigations  2014;19(1):127-137.
Objectives
The frequency and causes of chemosensory (taste and smell) disorders in cancer patients remain under-reported. This study examined the impact of cancer therapy on taste/smell functions and salivary constituents in brain tumor patients.
Materials and methods
Twenty-two newly diagnosed patients with primary malignant gliomas underwent 6 weeks of combined modality treatment (CMD) with radiation and temozolomide followed by six monthly cycles of temozolomide. Chemosensory functions were assessed at 0, 3, 6, 10, 18, and 30 weeks with paired samples of saliva collected before and after an oral rinse with ferrous-spiked water. Iron (Fe)-induced oxidative stress was measured by salivary lipid oxidation (SLO); salivary proteins, electrolytes, and metals were determined. Parallel salivary analyses were performed on 22 healthy subjects.
Results
Chemosensory complaints of cancer patients increased significantly during treatment (p=0.04) except at 30 weeks. Fe-induced SLO increased at 10 and 18 weeks. When compared with healthy subjects, SLO, total protein, Na, K, Cu, P, S, and Mg levels, as averaged across all times, were significantly higher (p<0.05), whereas salivary Zn, Fe, and oral pH levels were significantly lower in cancer patients (p<0.05). Neither time nor treatment had a significant impact on these salivary parameters in cancer patients.
Conclusions
Impact of CMT treatment on chemosensory functions can range from minimal to moderate impairment. Analysis of SLO, metals, and total protein do not provide for reliable measures of chemosensory dysfunctions over time.
Clinical relevance
Taste and smell functions are relevant in health and diseases; study of salivary constituents may provide clues on the causes of their dysfunctions.
doi:10.1007/s00784-014-1211-8
PMCID: PMC4156565  PMID: 24595687
Metallic flavor; Oral lipid oxidation; Cancer; Brain tumor; Chemotherapy; Saliva; Taste and smell
2.  Dental risk factors for osteonecrosis of the jaws: A CONDOR case–control study 
Clinical oral investigations  2012;17(8):10.1007/s00784-012-0880-4.
Background
Reports of osteonecrosis of the jaw (ONJ) have associated this lesion to treatment with bisphosphonates (BPs) and dental procedures. In this study, we investigated the association of specific dental diagnoses and procedures with ONJ among patients with past BP use.
Methods
Dentists from three Practice-Based Research Networks provided ONJ cases and controls (1:3). Data gathered from patients and dental offices with two respective standard questionnaires included demographic, medical, pharmaceutical, and dental information. Diagnoses and procedures up to three years prior to ONJ (prior to interview for controls) were analyzed within risk strata, defined by BP use and cancer status, using interaction terms within conditional logistic regression models.
Results
We enrolled 191 ONJ cases and 573 controls from 119 dental offices. Among participants who had used only oral BP, extraction was the only dental risk factor for ONJ (OR=12, p=0.01). Suppuration was also more prevalent in cases (18%) than in controls (9%), but not statistically significant (OR=9, p=0.06).
Among participants who had not used either oral or IV BP (a majority of whom received RT to the head and neck), suppuration was the only dental risk factor for ONJ (prevalence=34% for cases and 8% for controls; OR=7, p=0.01). The prevalence of extractions in this group was also higher, but not statistically significant (44% vs 10%; OR=3). Limited power precludes definitive findings among participants exposed to IV BP.
Conclusions
Among patients taking oral BP, extraction was the only dental procedure associated with subsequent ONJ development.
Clinical Relevance
Results of this study suggest that routine dental procedures are not associated with development of ONJ in patients exposed to BPs.
doi:10.1007/s00784-012-0880-4
PMCID: PMC3594331  PMID: 23212125
Osteonecrosis; jaws; bisphosphonates; dental diagnosis; dental treatment; risk factors
3.  Random Plasma Glucose Values Measured in Community Dental Practices: Findings from The Dental Practice-Based Research Network 
Clinical oral investigations  2012;17(5):1383-1388.
Objectives
To examine feasibility of testing and frequency of abnormal plasma glucose among dental patients in The Dental Practice-Based Research Network.
Methods
Eligible dental patients were >19 years old and had at least one American Diabetes Association-defined risk factor for diabetes mellitus, or an existing diagnosis of diabetes or pre-diabetes. Random (fasting not required) plasma glucose was measured in standardized fashion using a commercial glucometer. Readings <70 mg/dl or >300 mg/dl triggered re-testing. Patients with glucose >126 mg/dl were referred for medical follow up.
Results
Of 498 subjects in 28 dental practices, 491 (98%) consented and 418 (85.1%) qualified for testing. Fifty-one patients (12.2%) had diabetes; 24 (5.7%) had pre-diabetes. Glucose ranged from 50 – 465 mg/dl. 129 subjects (31%) had readings outside the normal range; of these, 28 (6.7%) had readings <80 mg/dl and 101 (24.2%) had readings >126 mg/dl; in 9 patients (7 with diabetes), glucose was >200 mg/dl.
Conclusions
A significant proportion of patients tested had abnormal blood glucose. Routine glucose testing in dental practice of populations at risk or diagnosed with diabetes may be beneficial and community dental practices hold promise as settings for diabetes and pre-diabetes screening and monitoring.
Clinical Relevance
Results suggest that implementation of glucose measurement in dental practice may provide important clinical and health information for both patients and practitioners.
doi:10.1007/s00784-012-0825-y
PMCID: PMC3509225  PMID: 22903529
diabetes; screening; dental practice
4.  Impact of orally administered lozenges with Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 on the number of salivary mutans streptococci, amount of plaque, gingival inflammation and the oral microbiome in healthy adults 
Objectives
The aim was to evaluate the effects of orally administered Lactobacillus rhamnosus GG (LGG) and Bifidobacterium animalis subsp. lactis BB-12 (BB-12) on the number of salivary mutans streptococci (MS), amount of plaque, gingival inflammation and the oral microbiota in healthy young adults.
Materials and methods
The study was a randomised, controlled, double-blind trial. Healthy volunteers used lozenges containing a combination of LGG and BB-12 (test group, n = 29) or lozenges without added probiotics (control group, n = 31) for 4 weeks. At baseline and at the end of the test period, the plaque index (PI) and gingival index (GI) were determined, and stimulated saliva was collected. The microbial composition of saliva was assessed using human oral microbe identification microarray (n = 30). MS and lactobacilli (LB) were plate cultured.
Results
The probiotic lozenge decreased both PI and GI (p < 0.05) while no changes were observed in the control group. However, no probiotic-induced changes were found in the microbial compositions of saliva in either group.
Conclusions
The probiotic lozenge improved the periodontal status without affecting the oral microbiota.
Clinical relevance
Short-term consumption of LGG and BB-12 decreased the amount of plaque which was associated with a clinical impact: a decrease in gingival inflammation.
doi:10.1007/s00784-014-1221-6
PMCID: PMC4286650  PMID: 24638207
Lactobacillus rhamnosus GG; Bifidobacterium lactis BB-12; Probiotic; HOMIM; Mutans streptococci; Lactobacilli; Plaque index; Gingival index
5.  Analysis of salivary fluid and chemosensory functions in patients treated for primary malignant brain tumors 
Clinical Oral Investigations  2014;19:127-137.
Objectives
The frequency and causes of chemosensory (taste and smell) disorders in cancer patients remain under-reported. This study examined the impact of cancer therapy on taste/smell functions and salivary constituents in brain tumor patients.
Materials and methods
Twenty-two newly diagnosed patients with primary malignant gliomas underwent 6 weeks of combined modality treatment (CMD) with radiation and temozolomide followed by six monthly cycles of temozolomide. Chemosensory functions were assessed at 0, 3, 6, 10, 18, and 30 weeks with paired samples of saliva collected before and after an oral rinse with ferrous-spiked water. Iron (Fe)-induced oxidative stress was measured by salivary lipid oxidation (SLO); salivary proteins, electrolytes, and metals were determined. Parallel salivary analyses were performed on 22 healthy subjects.
Results
Chemosensory complaints of cancer patients increased significantly during treatment (p = 0.04) except at 30 weeks. Fe-induced SLO increased at 10 and 18 weeks. When compared with healthy subjects, SLO, total protein, Na, K, Cu, P, S, and Mg levels, as averaged across all times, were significantly higher (p < 0.05), whereas salivary Zn, Fe, and oral pH levels were significantly lower in cancer patients (p < 0.05). Neither time nor treatment had a significant impact on these salivary parameters in cancer patients.
Conclusions
Impact of CMT treatment on chemosensory functions can range from minimal to moderate impairment. Analysis of SLO, metals, and total protein do not provide for reliable measures of chemosensory dysfunctions over time.
Clinical relevance
Taste and smell functions are relevant in health and diseases; study of salivary constituents may provide clues on the causes of their dysfunctions.
doi:10.1007/s00784-014-1211-8
PMCID: PMC4156565  PMID: 24595687
Metallic flavor; Oral lipid oxidation; Cancer; Brain tumor; Chemotherapy; Saliva; Taste and smell
6.  Development and validation of an in vitro model for measurements of cervical root dentine permeability 
Clinical Oral Investigations  2014;18(9):2077-2086.
Objectives
The aim of this series of studies was the development and validation of a new model for evaluation of dentinal hypersensitivity (DH) therapies.
Materials and methods
Roots from extracted human teeth were sealed with a flowable composite. In the cervical area, a 3-mm-wide circular window was ground through the seal 1 mm deep into dentine. The pulp lumen was connected to a reservoir of artificial dentinal fluid (ADF) containing protein, mineral salts and methylene blue. At increased pulpal pressure, the ADF released through the said window was collected in containers each with 20 ml of physiologic saline for a consecutive series of 30-min intervals and ADF concentration (absorption) was determined photometrically. The model was verified by three experiments. In experiment 1, the lower limit of quantification (LLoQ, coefficient of variation = 20 % and difference of 5 standard deviations (SD) from blank) of ADF in physiologic saline was determined by measuring the absorption of 15 dilutions of ADF in physiologic saline (containing 0.625 ng to 12.5 μg methylene blue/ml) photometrically for ten times. In experiment 2, long-term linearity of ADF perfusion/outflow was investigated using 11 specimens. The ADF released through the window was collected in the said containers separately for each consecutive interval of 30 min for up to 240 min. Absorption was determined and analysed by linear regression over time. In experiment 3, perfusion before (2×) and after single treatment according to the following three groups was measured: BisGMA-based sealant (Seal&Protect®), an acidic fluoride solution (elmex fluid®) and control (no treatment).
Results
In experiment 1, the LLoQ was 0.005 μg methylene blue/ml. In experiment 2, permeability was different within the specimens and decreased highly linearly with time, allowing the prediction of future values. In experiment 3, Seal&Protect® completely occluded dentinal tubules. elmex fluid® increased tubular permeability by about 30 % compared to control.
Conclusions
A model comprising the use of artificial dentinal fluid was developed and validated allowing screening of therapeutic agents for the treatment of DH through reliable measurement of permeability of cervical root dentine.
Clinical relevance
The described in vitro model allows evaluation of potential agents for the treatment of DH at the clinically relevant cervical region of human teeth.
doi:10.1007/s00784-014-1194-5
PMCID: PMC4232750  PMID: 24504375
Dentine hypersensitivity; DH; Perfusion; Tubules; Dentinal fluid; Fluoride; Protein
7.  The osteoblastic differentiation ability of human dedifferentiated fat cells is higher than that of adipose stem cells from the buccal fat pad 
Clinical Oral Investigations  2013;18(8):1893-1901.
Objectives
The purpose of this study was to evaluate and compare the osteoblastic differentiation ability of dedifferentiated fat (DFAT) cells and adipose stem cells (ASCs) from the buccal fat pad (BFP).
Materials and methods
We isolated human DFAT cells and ASCs from the BFP of a patient who underwent oral and maxillofacial surgery and then analyzed their cell surface antigens by flow cytometry. Then, the cells were cultured in osteogenic medium for 14 days. Measurement of bone-specific alkaline phosphatase (BAP), osteocalcin (OCN), and calcium deposition and alizarin red staining were performed to evaluate the osteoblastic differentiation ability of both cell types.
Results
ASCs and DFAT cells were positive for CD90 and CD105 and negative for CD11b, CD34, and CD45. BAP (days 3 and 7), OCN (day 14), and calcium deposition (days 7 and 14) within DFAT cell cultures were significantly higher than those in ASC cultures. The alizarin red-stained area in DFAT cell cultures, which indicates mineralized matrix deposition, was stained more strongly than that in ASC cultures.
Conclusions
The cell surface antigens of ASCs and DFAT cells tend to be similar. Furthermore, the osteoblastic differentiation ability of human DFAT cells is higher than that of ASCs from the BFP.
Clinical relevance
Isolation of DFAT cells from the BFP has an esthetic advantage because the BFP can be obtained via the oral cavity without injury to the external body surface. Therefore, we consider that DFAT cells from the BFP are an ideal cell source for bone tissue engineering.
doi:10.1007/s00784-013-1166-1
PMCID: PMC4212158  PMID: 24362590
Dedifferentiated fat cells; Adipose stem cells; Ceiling culture; Buccal fat pad; Osteoblastic differentiation; Bone tissue engineering
8.  The association of chronic apical periodontitis and endodontic therapy with atherosclerosis 
Clinical Oral Investigations  2013;18(7):1813-1823.
Objectives
Chronic apical periodontitis (CAP) appears to be a risk factor for coronary heart disease. The aims of the study were to estimate the significance of AP for the atherosclerotic burden and to examine the potential effect of endodontic treatment.
Materials and methods
The whole-body computed tomography (CT) examinations of 531 patients with a mean age of 50 ± 15.7 years were evaluated retrospectively. The atherosclerotic burden of the abdominal aorta was quantified using a calcium scoring method. The parameters of periodontitis were measured using the CT scan.
Results
The patients had a total of 11,191 teeth. The volume of the aortic atherosclerotic burden for patients with at least one CAP lesion was 0.32 ± 0.92 ml, higher than for patients with no CAP (0.17 ± 0.51 ml; p < 0.05). The atherosclerotic burden increased with age and number of CAP lesions without root canal treatment, but not with number of CAP lesions with endodontic treatments (p < 0.05 each). In logistic regression models, age (Wald 90.8), CAP without endodontic treatment (Wald 39.9), male gender (Wald 9.8), and caries per tooth (Wald 9.0) correlated positively and the number of fillings (Wald 11) correlated negatively with the atherosclerotic burden (p < 0.05 each). Apical radiolucencies in teeth with endodontic treatment were irrelevant with respect to atherosclerosis.
Conclusions
CAP correlated positively with the aortic atherosclerotic burden. In regression models, CAP without endodontic treatment was found to be an important factor, not however apical radiolucencies in teeth with endodontic treatment.
Clinical relevance
Further research is needed to clarify the possible clinical significance of these associations.
doi:10.1007/s00784-013-1156-3
PMCID: PMC4145204  PMID: 24338091
Atherosclerosis; Periapical periodontitis; Marginal periodontitis; Multidetector computed tomography
9.  Increased frequency of CD4+ CD25+ FOXP3+ cells correlates with the progression of 4-nitroquinoline1-oxide-induced rat tongue carcinogenesis 
Clinical Oral Investigations  2013;18(7):1725-1730.
Objectives
CD4+ CD25+ FoxP3+ T cells (Tregs) play an essential role in sustaining self-tolerance by negatively regulating immune responses. Increased frequencies of Tregs have been reported in a variety of human cancers. The aim of this study was to evaluate the prevalence of Tregs infiltration in the peripheral blood and regional lymph nodes during rat tongue carcinogenesis induced by 4-nitroquinoline-1-oxide (4NQO).
Materials and methods
Forty-eight Sprague–Dawley rats were divided into the control (n = 16) and experimental groups (n = 32) to which 4NQO in drinking water was administered. Flow cytometry was used to analyze the prevalence of Tregs in lymphocytes of peripheral blood and regional lymph nodes during 4NQO-induced rat tongue carcinogenesis. CD4+ CD25+ FoxP3+ cells were expressed as a percentage of the total CD4+ cells.
Results
The frequency of Tregs in peripheral blood from squamous cell carcinoma rats was significantly higher than controls (3.82 ± 0.62 versus 1.40 ± 0.31 %, P < 0.001). The proportion of Tregs was sequentially increased from moderate dysplasia to severe dysplasia and SCC (1.94 ± 0.72, 2.29 ± 0.82, and 3.82 ± 0.62 %, respectively). The frequency of Tregs in regional lymph nodes from squamous cell carcinoma rats was also significantly higher than normal rat mucosa (14.67 ± 3.09 versus 5.53 ± 2.07 %, P < 0.001). The percentage of Tregs was gradually increased in moderate dysplasia, severe dysplasia, and SCC groups (8.93 ± 1.74, 10.15 ± 0.86, 14.67 ± 3.09 %, respectively) as compared to control group (5.53 ± 2.07 %).
Conclusion and clinical relevance
Tregs in peripheral blood and lymph nodes were associated with disease progression during 4NQO-induced rat tongue carcinogenesis. This study indicated that the upregulation of Tregs might play important role during oral mucosa malignant transformation.
doi:10.1007/s00784-013-1146-5
PMCID: PMC4145201  PMID: 24264641
Treg; Oral squamous cell carcinoma; 4-nitroquinoline 1-oxide
10.  Effect of a daily dose of Lactobacillus brevis CD2 lozenges in high caries risk schoolchildren 
Clinical Oral Investigations  2013;18(2):555-561.
Objectives
A double-blind, randomised, placebo-controlled clinical trial was performed to validate the hypothesis that the use of lozenges containing Lactobacillus brevis CD2 (Inersan®, CD Investments srl) may reduce plaque pH, salivary mutans streptococci (ms) and bleeding on probing, during a 6-week period, in a sample of high caries risk schoolchildren.
Methods
A total of 191 children (aged 6–8 years), presenting two to three carious lesions and a salivary ms concentration of ≥105 CFU/ml, were enrolled and divided into two groups, an L. brevis CD2 lozenge group and a no L. brevis lozenge group, and examined at baseline (t0), after 3 weeks (t1), after 6 weeks of lozenge use (t2) and 2 weeks after the cessation of lozenge use (t3). Plaque pH was assessed using the microtouch technique following a sucrose challenge. The area under the curve (AUC5.7 and AUC6.2) was recorded. Salivary ms were counted, and bleeding on probing was assessed.
Results
At t0, the plaque-pH and ms concentration values were similar in both groups. Mean areas (AUC5.7 and AUC6.2) were significantly greater in the control group at t1, t2 and t3. L. brevis CD2 lozenges significantly reduced salivary ms concentrations and bleeding. The subjects from the test group showed a statistically significant decrease (p = 0.01) in salivary ms concentration. At t2, a statistically significantly lower bleeding value was recorded in the test group compared with the control group (p = 0.02).
Conclusions
Six weeks’ use of lozenges containing L. brevis CD2 had a beneficial effect on some important variables related to oral health, including a reduction in plaque acidogenicity, salivary ms and bleeding on probing. (Trial Registration Number NCT01601145 08/21/2012)
doi:10.1007/s00784-013-0980-9
PMCID: PMC3936134  PMID: 23644602
Probiotic; Lactobacillus brevis CD2; Caries; Plaque pH; Salivary mutans streptococci; Children
11.  Current diagnosis of dentin hypersensitivity in the dental office: an overview 
Clinical Oral Investigations  2013;17(Suppl 1):21-29.
Objectives
The aim of this overview is to consider the problems that may be associated with making a diagnosis of dentin hypersensitivity (DHS) and to provide a basis for clinicians to effectively diagnose and manage this troublesome clinical condition.
Materials and methods
A PUBMED literature research was conducted by the author using the following MESH terms: (‘diagnosis’[Subheading] OR ‘diagnosis’[All Fields] OR ‘diagnosis’[MeSH Terms]) AND (‘therapy’[Subheading] OR ‘therapy’[All Fields] OR ‘treatment’[All Fields] OR ‘therapeutics’[MeSH Terms] OR ‘therapeutics’[All Fields]) AND (‘dentin Sensitivity’[MeSH Terms] OR (‘dentin’[All Fields] AND ‘sensitivity’[All Fields]) OR ‘dentin sensitivity’[All Fields]). Variations to the above MeSH terms using terms such as ‘cervical’, ‘dentine’ and ‘hypersensitivity’ as substitutes were also explored, but these searches failed to add any further information.
Results
The literature search provided only limited data on specific papers relating to the clinical diagnosis of DHS by dental professionals. Evidence from these published studies would therefore indicate that clinicians are not routinely examining their patients for DHS or eliminating other possible causes of dental pain (differential diagnosis) prior to subsequent management and may rely on their patients’ self-reporting of the problem. Furthermore, the findings of the Canadian Consensus Document (2003) would also suggest that clinicians are not confident of successfully treating DHS.
Conclusions
It is apparent from reviewing the published literature on the diagnosis of DHS that there are a number of outstanding issues that need to be resolved, for example, (1) is the condition under- or overestimated by dentists, (2) is the condition adequately diagnosed and successfully managed by dentists in daily practice, (3) is the impact of DHS on the quality of life of sufferers adequately diagnosed and treated and (4) is the condition adequately monitored by clinicians in daily practice. These and other questions arising from the workshop forum should be addressed in well-conducted epidemiological and clinical studies in order for clinicians to be confident in both identifying and diagnosing DHS and subsequent management that will either reduce or eliminate the impact of DHS on their patients’ quality of life.
Clinical relevance
Clinicians should be made aware not only of the importance of identifying patients with DHS but also of the relevance of a correct diagnosis that may exclude any confounding factors from other oro-facial pain conditions prior to the successful management of the condition.
doi:10.1007/s00784-012-0911-1
PMCID: PMC3586159  PMID: 23296425
Dentin hypersensitivity; Diagnosis; Differential diagnosis; Diagnostic tools; Clinical management
12.  Current management of dentin hypersensitivity 
Clinical Oral Investigations  2012;17(Suppl 1):55-59.
Objectives
The aim of the article was to present an overview of the management strategies of dentin hypersensitivity (DHS) and summarize and discuss the therapeutic options.
Materials and methods
A PubMed literature search was conducted to identify articles dealing with dentin hypersensitivity prophylaxis and treatment. We focussed on meta-analyses of available or controlled clinical trials.
Results
DHS therapy should start with noninvasive individual prophylactic home-care approaches. In-office therapy follows with nerve desensitizing, precipitating, or plugging agents. If the hypersensitivity persists, depending on the hard and soft tissue components at reevaluation, i.e., presence or absence of cervical lesions and the gingival contour, adhesive restorations including sealing or mucogingival surgery may be an option. They allow for the establishment of a physicomechanical barrier. As the placebo effect may play an important role, adequate patient management strategies and positive reinforcement may improve the management of DHS in the future.
Conclusions
Lifelong maintenance under the premise of strict control of the causative factors is crucial in the management of DHS.
Clinical relevance
Clinicians are faced with a broad spectrum of therapeutic options. Therapy should not only focus on pain reduction or better elimination but also on the modification of the exposed cervical dentin area based on the defect type.
doi:10.1007/s00784-012-0912-0
PMCID: PMC3585982  PMID: 22350036
Dentin hypersensitivity; Therapy; Review
13.  Discussion: how can we improve diagnosis of dentin hypersensitivity in the dental office? 
Clinical Oral Investigations  2012;17(Suppl 1):53-54.
doi:10.1007/s00784-012-0913-z
PMCID: PMC3585981  PMID: 23269545
Dentin hypersensitivity; Diagnosis of DHS; Dentinal pain
14.  The role of fluoride in the preventive management of dentin hypersensitivity and root caries 
Clinical Oral Investigations  2012;17(Suppl 1):63-71.
Objective
The objectives were to bring light on fluoride to control dentin hypersensitivity (DHS) and prevent root caries.
Materials and methods
Search strategy included papers mainly published in PubMed, Medline from October 2000 to October 2011.
Results
Fluoride toothpaste shows a fair effect on sensitive teeth when combined with dentin fluid-obstructing agents such as different metal ions, potassium, and oxalates. Fluoride in solution, gel, and varnish give an instant and long-term relief of dentin and bleaching hypersensitivity. Combined with laser technology, a limited additional positive effect is achieved. Prevention of root caries is favored by toothpaste with 5,000 ppm F and by fluoride rinsing with 0.025–0.1 % F solutions, as the application of fluoride gel or fluoride varnish three to four times a year. Fluoride measures with tablets, chewing gum, toothpick, and flossing may be questioned because of unfavorable cost effectiveness ratio.
Conclusion
Most fluoride preparations in combination with dentin fluid obstruction agents are beneficial to reduce DHS. Prevention of root caries is favorable with higher fluoride concentrations in, e.g., toothpaste.
Clinical relevance
Fluoride is an effective agent to control DHS and to prevent root caries particularly when used in higher concentrations.
doi:10.1007/s00784-012-0916-9
PMCID: PMC3586140  PMID: 23271217
Fluoride; Prevention; Sensitive teeth; Hypersensitivity; Root caries
15.  What are the unmet needs in the dental office/at home to treat dentin hypersensitivity? 
Clinical Oral Investigations  2012;17(Suppl 1):61-62.
doi:10.1007/s00784-012-0914-y
PMCID: PMC3586158  PMID: 23271216
Dentin hypersensitivity; Etiology; Diagnosis; Therapy
16.  Foreword 
Clinical Oral Investigations  2012;17(Suppl 1):1-2.
doi:10.1007/s00784-012-0917-8
PMCID: PMC3586138  PMID: 22453515
Dentin; Hypersensitivity; Prevalence; Hydrodynamic theory
17.  How to make a link between Oral Health-Related Quality of Life and dentin hypersensitivity in the dental office? 
Clinical Oral Investigations  2012;17(Suppl 1):41-44.
Objectives
Oral Health-Related Quality of Life (OHRQoL) can be considered as the scientific expression of that part of a person’s well-being that is affected by his/her oral health. The aim of this paper was to evaluate how to use the data available in the field of research to make a link between OHRQoL and dentin hypersensitivity (DHS) in the dental office.
Materials and methods
Research papers in the field of OHRQoL and DHS and reviews and research papers about OHRQoL were used for analysis in this short review, with a particular insight on the instruments used to evaluate OHRQoL.
Results
Various psychometric instruments have been used to measure OHRQoL that are more or less patient- or expert-centred. Some are generic, others are adapted to specific conditions/domains or populations. The impact of DHS or exposed cervical dentin (ECD) on OHRQoL has been assessed in very few studies. It is therefore of the upmost importance that the use of the OHRQoL as a quality control tool be established in robust clinical studies.
Conclusions/clinical relevance
Future studies evaluating the impact of the DHS/ECD on OHQoL or evaluating the efficacy of desensitising agents should respect some key points, including study design (randomization, placebo/control group, etc.), validated specific questionnaires and trained calibrated practitioners.
doi:10.1007/s00784-012-0915-x
PMCID: PMC3585693  PMID: 23262836
Oral Health-Related Quality of Life; Dentin hypersensitivity; Exposed cervical dentin
18.  A decision tree for the management of exposed cervical dentin (ECD) and dentin hypersensitivity (DHS) 
Clinical Oral Investigations  2012;17(Suppl 1):77-83.
Introduction
Dentin hypersensitivity (DHS) is a problematic clinical entity that may become an increasing clinical problem for dentists to treat as a consequence of patients retaining their teeth throughout life and improved oral hygiene practices.
Objectives
The aim of this review was to develop a decision tree for the management of exposed cervical dentin (ECD) and DHS.
Material and methods
A brief PUBMED literature search was performed on dentin hypersensitivity using “MeSH” terms, “review”, and “management”. In addition, some websites and local guidelines were screened.
Results
From this review, it became clear that all dentate patients should routinely be screened for ECD and DHS. In this respect, underdiagnosis of the condition will be avoided and the preventive management can be initiated early.
Conclusion
A decision tree process and a flowchart for daily practice were designed which should be started up as soon as a patient present with ECD or suffers from DHS. This approach takes into account the possible improved quality of life of the patient and is further based on a hierarchy of treatment options. In this respect, active management of DHS will usually involve a combination of at-home and in-office therapies. Starting with the use of desensitizing toothpastes is strongly recommended.
doi:10.1007/s00784-012-0898-7
PMCID: PMC3585983  PMID: 23262746
Exposed cervical dentine; Dentine Hypersensitivity; Review
19.  Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin 
Clinical Oral Investigations  2012;17(Suppl 1):9-19.
Objectives
The paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.
Materials and methods
Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).
Results
The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.
Conclusions
The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.
Clinical relevance
Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.
doi:10.1007/s00784-012-0887-x
PMCID: PMC3585766  PMID: 22695872
Dentin hypersensitivity (DHS); Gingival recession; Non-caries cervical lesions (NCCL); Abrasion; Erosion; Abfraction
20.  Exposed cervical dentin and dentin hypersensitivity summary of the discussion and recommendations 
Clinical Oral Investigations  2012;17(Suppl 1):73-76.
doi:10.1007/s00784-012-0902-2
PMCID: PMC3585836  PMID: 23224117
Exposed cervical dentin; Dentin hypersensitivity; Oral health-related quality of life
21.  Epidemiology of dentin hypersensitivity 
Clinical Oral Investigations  2012;17(Suppl 1):3-8.
Objective
In contrast to the well-established caries epidemiology, data on dentin hypersensitivity seem to be scarce and contradictory. This review evaluates the available literature on dentin hypersensitivity and assesses its prevalence, distribution, and potential changes.
Materials and methods
The systematic search was performed to identify and select relevant publications with several key words in electronic databases. In addition, the articles’ bibliographies were consulted.
Results
Prevalence rates range from 3 to 98 %. This vast range can be explained partly by the differences in the selection criteria for the study sample and also the variety in diagnostic approaches or time frames. Women are slightly more affected than men and an age peak of 30–40 years has been reported. Still, the prevalence of erosions with dentin exposure seems to increase in younger adults, often resulting in hypersensitivity. In older patients, root surfaces are frequently exposed due to periodontal disease which is associated with a high rate of dentin hypersensitivity, especially after periodontal treatment and intensified brushing activity. On the other hand, the number of affected seniors with tooth loss or even edentulism is reduced. About 25–30 % of the adult population report dentin hypersensitivity. Most dentists also consider it to be a relevant problem in their practice, but they request more information on this topic. Maxillary teeth are affected to a higher extent, but the different teeth show very similar rates. Buccal surfaces clearly show the highest prevalence rates.
Conclusion
In spite of the advances regarding management of dentin hypersensitivity, it still remains an epidemiologically understudied field.
Clinical relevance
Although great variations have been observed in the prevalence of dentin hypersensitivity, this issue is often observed by dentists and related by patients. However, further studies are necessary to find the cause of this condition and refine its management.
doi:10.1007/s00784-012-0889-8
PMCID: PMC3585833  PMID: 23224064
Epidemiology; Prevalence; Dentin(e) hypersensitivity; Age; Gender
22.  How valid and applicable are current diagnostic criteria and assessment methods for dentin hypersensitivity? An overview 
Clinical Oral Investigations  2012;17(Suppl 1):31-40.
Objectives
Although dentin hypersensitivity is a common clinical condition and is generally reported by the patient after experiencing a sharp, short pain caused by one of several different external stimuli, it is often inadequately understood. The purpose of this paper is to discuss different available diagnostic approaches and assessment methods used in order to suggest a basis to diagnose, monitor, and measure these challenging painful conditions related to dentin hypersensitivity in daily practice and scientific projects properly.
Material and methods
A PubMed literature search strategy including the following MeSH terms were used as follows: “dentin sensitivity”[MeSH Terms] OR “dentin”[All Fields] AND “sensitivity”[All Fields] OR “dentin sensitivity”[All Fields] OR “dentin”[All Fields] AND “hypersensitivity”[All Fields] OR “dentin hypersensitivity”[All Fields] AND “diagnosis”[Subheading] OR “diagnosis”[All Fields] OR “diagnosis”[MeSH Terms] AND “assessment”[All Fields] AND (“methods”[Subheading] OR “methods”[All Fields] OR “methods”[MeSH Terms]. Furthermore, alternative terms such as “validity,” “reliability,” “root,” “cervical,” “diagnostic criteria,” and “hypersensitivities” were additionally evaluated.
Results
The literature search, also including the alternative terms and journals, revealed only a small number of specific papers related to valid diagnosis, diagnostic criteria, and assessment methods of dentin hypersensitivity. Outcomes from these publications showed that the response to different stimuli varies substantially from one person to another and is, due to individual factors, often difficult to assess correctly. Furthermore, the cause of the reported pain can vary, and the patient’s description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.
Conclusions
The dental practitioner, using a variety of diagnostic and measurement techniques each day, will often have difficulties in differentiating dentin hypersensitivity from other painful conditions and in evaluating the success of a conducted therapy in a reliable way.
Clinical relevance
Correct diagnosis of dentin hypersensitivity including a patient’s history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential. The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.
doi:10.1007/s00784-012-0891-1
PMCID: PMC3585843  PMID: 23224044
Dentin hypersensitivity; Diagnosis; Differential diagnosis; Diagnostic criteria; Dentin hypersensitivity assessment; Monitoring dentin hypersensitivity
23.  What is known about the influence of dentine hypersensitivity on oral health-related quality of life? 
Clinical Oral Investigations  2012;17(Suppl 1):45-51.
Objectives
Oral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient’s perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient’s quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS.
Material and methods
A PubMed literature research was conducted using the terms (“dentin sensitivity” [MeSH Terms] OR (“dentin” [All Fields] AND “sensitivity” [All Fields]) OR “dentin sensitivity” [All Fields]) AND ((“oral health” [MeSH Terms] OR (“oral” [All Fields] AND “health” [All Fields]) OR “oral health” [All Fields]) AND related [All Fields] AND (“quality of life” [MeSH Terms] OR (“quality” [All Fields] AND “life” [All Fields]) OR “quality of life” [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review.
Results
The combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS.
Conclusions
Patients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research.
Clinical relevance
Oral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients’ OHRQoL.
doi:10.1007/s00784-012-0888-9
PMCID: PMC3585945  PMID: 22290063
Oral health-related quality of life (OHRQoL); Dentine hypersensitivity; Oral Health Impact Profile (OHIP); Dentine Hypersensitivity Experience Questionnaire (DHEQ)
24.  Functional dental status and oral health-related quality of life in an over 40 years old Chinese population 
Clinical Oral Investigations  2012;17(6):1471-1480.
Objectives
This study aimed to assess oral health-related quality of life (OHRQoL) related to dental status.
Material and methods
One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. OHIP-14CN scores were used to assess OHRQoL and analyzed using multivariable logistic regression including five dental conditions (‘≥10 teeth in each jaw’; ‘complete anterior regions’; ‘sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement) after adjustment for five background variables. Likelihood ratios for impaired OHRQoL (OHIP total score ≥5) were assessed at each level of the classification system.
Results
In the hierarchical scheme, OHIP-14CN total scores were highest in branch ‘<10 teeth in each jaw’ (8.5 ± 9.5 to 12.3 ± 13.2). In branch ‘≥10 teeth’ scores ranged from 6.2 ± 7.7 to 8.3 ± 9.3. The most important dental condition discriminating for impact on OHRQoL was ‘≥10 teeth in each jaw’ (Likelihood ratio 1.59). In this branch subsequent levels were discriminative for impaired OHRQoL (Likelihoods 1.29–1.69), in the branch ‘<10 teeth in each jaw’ they were not (Likelihoods 0.99–1.04). Tooth replacements were perceived poorer as their natural counterparts (odd ratios, 1.30 for fixed and 1.47 for removable appliances).
Conclusions
OHRQoL was strongly associated with the presence of at least 10 teeth in each jaw. The hierarchical classification system predicted approximately 60 % of subjects correctly with respect to impaired OHRQoL.
Clinical relevance
From an OHRQoL perspective, natural teeth were preferred over artificial teeth.
doi:10.1007/s00784-012-0834-x
PMCID: PMC3691481  PMID: 23015025
Oral health-related quality of life; Occlusal status; Hierarchical dental functional classification system; Chinese adults
25.  Chewing ability in an urban and rural population over 40 years in Shandong Province, China 
Clinical Oral Investigations  2012;17(5):1425-1435.
Objectives
This study aimed to assess chewing ability related to dental status.
Material and methods
One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. Chewing ability was analyzed using multivariable logistic regression including five dental conditions (≥10 teeth in each jaw’; ‘complete anterior regions’; “sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement), adjusted for six background variables. Likelihood ratios for chewing problems were assessed at each level of the hierarchical classification system based on these dental conditions.
Results
Seventy-eight to 91 % of subjects reported no or minor chewing problems. The conditions ‘≥10 teeth in each jaw’, and ‘complete anterior regions’ were not associated, whereas ‘sufficient’ premolar regions’ and ‘sufficient molar regions’ were associated with chewing problems (Ors, 0.33–0.58). If classified hierarchically, the condition ‘≥10 teeth in each jaw’ was relevant for chewing problems (likelihood ratios 3.3–3.7). ‘Sufficient premolar region’ and ‘sufficient molar region’ were relevant to reduce the likelihood ratios for having chewing problems (both approximately with a factor 2), both for soft and for hard foods. Subjects with artificial teeth added had similar chance for chewing problems compared to counterparts with natural teeth only. However, if comparing replaced teeth with natural teeth, subjects with tooth replacement showed higher chance for chewing problems.
Conclusions
Chewing ability was strongly associated with dental conditions.
Clinical relevance
The presence of at least 10 teeth in each jaw had highest impact on chewing ability.
doi:10.1007/s00784-012-0822-1
PMCID: PMC3663989  PMID: 22940739
Chewing ability; Occlusal status; Hierarchical dental functional classification system; Chinese adults

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