2
A trial performed in a public dental clinic used a blood glucose monitor to screen for diabetes. The monitor was easy to set up. A small cardboard test strip was loaded into the barrier-wrapped monitor just before use during the periodontal assessment. Anterior sites with a periodon- tal probing depth of at least 3 mm were preferred and pro- vided suitable GCB volume. The site was selected, the area was gently cleared of plaque and debris, then it was rinsed, dried, and reprobed to ensure an uncontaminated sample. The loaded test strip was brought into contact with the GCB, avoiding contact with the tooth or gingival tissue (Fig 3). The sample was collected and processed within 5 s(Fig 4). The monitor was then set aside and the periodon- tal assessment completed. Participants were satisfied with the screening procedure and were more interested in learn- ing about diabetes and its importance to oral health. Clinical Significance.—The ability to screen for diabetes in a dental setting appears to be a sim- ply and seemingly cost-effective measure that should be well-received by patients. Appropriate follow-up with patients who have increased blood glucose levels could be included with den- tal appointment reminders. This could also serve as a check on diabetes diagnostic testing out- comes. The screening should be accompanied by health education for the patient so he or she becomes more aware of the link between oral and systemic health. A cost-effectiveness analysis should be conducted along with an investigation into the efficacy of the GCB glucose screening model and patient and provider satisfaction levels with the process. Garton BJ, Ford PJ: Root caries and diabetes: Risk assessing to improve oral and systemic health outcomes. Austral Dent J 57:114-122, 2012 Reprints available from P Ford, School of Dentistry, The Univ of Queensland, 200 Turbot St, Brisbane, QLD 4000, Australia; e-mail: [email protected] Orthodontics Retention Background.—After orthodontic treatment, teeth tend to return to their initial position, so a retention phase is an integral part of orthodontic treatment. Factors that contrib- ute to relapse of position include periodontal causes (bone, periodontal ligament, and gingival fibers remodeling), ac- tive growth after treatment, habits that exert forces for 6- 8 h a day or more, and normal maturation and decrease in arch perimeter (adjustments). As a result, arch length and intercanine distance decrease and mandibular crowd- ing increases. The timing and extent of relapse cannot be determined individually, nor are there pretreatment vari- ables that predict relapse. Despite this known situation, few research data provide a foundation for the clinical basis of retention. Types of Retainers.—Fixed or bonded retainers can be made of thick or multistranded wire. Thick wire is bonded to two or three teeth, whereas multistranded wire is bonded to three or more teeth (Fig 1). Removable retainers include acrylic/wire types, clear thermoplastic types, and other designs. The acrylic/wire (Hawley) retainers are rigid but adjustable and permit the occlusion to settle somewhat. However, they are not as es- thetic as other options. The clear thermoplastic retainers offer good esthetics and can be readily fabricated. However, their occlusal coverage does not permit settling. Positioners and silicone-based retainers are also used. Evidence-Based Use of Retainers.—The principal concerns associated with retention are efficacy, meaning the retainer actually maintains orthodontic correction; breakage and repairs with fixed retainers; and long-term effects in terms of periodontal, gingival, and dental param- eters with respect to adjacent teeth. Fixed retainers are bonded to incisors and can retain tooth alignment. Canine-only bonded retainers maintain orthodontic align- ment for most patients, but incisor irregularity can de- velop in some cases. Removable retainers are only as effective as patient compliance permits. Most patients comply with retainer wear less and less over time, with fewer than half of patients wearing retainers as directed 2 years after completing orthodontic treatment. However, among removable retainers, clear thermoplastic retainers are associated with better patient satisfaction and compli- ance than are acrylic/wire-type retainers. In addition, 134 Dental Abstracts
