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: jkuehn@dent.med.uni-muenchen.de

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%.

Volume 58 � Issue 1 � 2013 37

Discussion.—Oral health problems are more commonin patients with various EDs. Patient assessment and treat-ment decisions should be geared to identifying and manag-ing these problems.

38

Clinical Significance.—Dental professionalsshould be alert to symptoms and signs of EDsamong their patients. This includes the pres-ence of dental problems, burning mouth, dryand cracked lips, gingival bleeding index, anddental erosion. This awareness should help de-tect and diagnose EDs, which is an essential firststep toward successful management. Then steps

Figtosres14

Dental Abstracts

can be taken to prevent further psychiatricproblems, somatic disturbances, and oraldeterioration.

Johansson A-K, Norring C, Unell L, et al: Eating disorders and oralhealth: a matched case-control study. Eur J Oral Sci 120:61-68, 2012

Reprints available from A-K Johansson, Dept. of Clinical Den-tistry—Cariology, Faculty of Medicine and Dentistry, Univ. ofBergen, �Arstadveien 17, 5009 Bergen, Norway; e-mail: ann-katrin.johansson@iko.uib.no

EndodonticsElectric pulp testing

1.—Mean threshold values for each group. (Courtesy of Filippa-CG, Tsatsoulis IN, Floratos S, et al: The variability of electric pulpponse threshold in premolars: a clinical study. J Endod 38:144-7, 2012.)

Background.—Pulp vitality tests reveal important as-pects of the pulp status. Electric pulp testers (EPTs) delivera current that can overcome the thickness of enamel anddentin and stimulate the myelinated sensory (Ad) fibers.However, false-positive and false-negative results can occur.Factors that influence electric pulp test results include thethickness of enamel and dentin, the concentration of sen-sory Ad fibers, the direction of dentinal tubules at the sitewhere the electrode tip is placed, and the pulp chambersize. Electric threshold response may also be affected by pa-tient age. As a result of many factors, the results of electricpulp testing vary from one tooth to another and from onearea of the tooth crown to another. A clinical study was un-dertaken to determine the variability of threshold EPT valuefrom site to site on the surfaces of four premolars. The re-lationship between EPT threshold value and age was alsoexplored.

Methods.—Ninety-seven volunteers age 20-72 yearswere divided into six age groups: 20-29 years, 30-39 years,40-49 years, 50-59 years, 60-69 years, and 70-79 years. Testswere carried out on all intact premolars in each dental arch.The sites tested were the tip of the buccal cusp, the centerof the middle, and the cervical third of the buccal surface.

Results.—Six hundred fifty-five premolars were tested,with a total of 1965 EPTreadings obtained. Mean thresholdvalues increased progressively with age from the first group(15.64) to the last group (49.26) (Fig 1). The differences be-tween the various groups were all statistically significant.More intense effects for age were noted for the mandibularpremolars. The difference in threshold values between the

mandibular and maxillary premolars declined with age. Sec-ond premolars had significantly higher mean thresholdvalues than first premolars. Mandibular premolars had sig-nificantly lower values than maxillary premolars in the per-sons of the same age.

First mandibular premolars demonstrated a significantdifference between readings at the cusp tip and those atthe cervical third of the crown. Second mandibular