Eye safety in operative dentistry — A study in general dental practice

AIM

In this safety conscious age all general dental practitioners should be promoting the use of eye protection. The aim of this study was to highlight the uptake of eye protection by all clinical staff and patients within the general dental practice setting, with regard to adequate protection and its use at appropriate times.

METHOD

Questionnaires were sent to 200 GDPs, chosen at random, to accumulate information on the use of protection, the preferred methods of eye protection and any experience of ocular injury.

FINDINGS

Eighty-seven per cent of GDPs wore eye protection routinely, but their choice of protection was not always adequate and not worn for all procedures. Forty-eight per cent of GDPs had experience of ocular trauma or infection which occurred during a variety of procedures; 75% of these injuries resulted from not wearing eye protection. In contrast less than half of the DNs and Hygienists use protection routinely, particularly when cleaning contaminated instruments. However, hygienists did wear eye protection for the majority of their patient work (96%).

CONCLUSION

Eye protection use by all staff and patients is currently suboptimal to conform to published guidelines. Risks encountered within the dental environment do cause harm to the unprotected eye, which can be reduced or even eliminated by improving the uptake of suitable eye protection; several choices for eye protection are available. Each individual dentist is responsible for the uptake of eye protection for all persons in their surgery environment.

Spatially-oriented EMR for dental surgery

As digital dental images become widely available, a new Electronic MR system (EMR) will be critical for the success of applying new technology to dental care. This project is designed an image-based and spatially-oriented EMR for dental surgery. A new panoramic image-based annotation model will be developed, which will complement dental charting precisely locating specific spatial findings for each patient. A spatially-oriented, multilayered data model for dental EMR will be developed using Geographic Information System (GIS) methods. This project will explore the possibility of applying head and neck images from VHP into a spatially-oriented EMR system.

Bispectral index system (BIS) monitoring reduces time to extubation and discharge in children requiring oral presedation and general anesthesia for outpatient dental rehabilitation

PURPOSE

Pediatric oral rehabilitation patients who receive presedation with oral Versed and general anesthesia (GA) occasionally experience prolonged sedation and delayed discharge. The Bispectral Index System (BIS) is an EEG monitor that measures the anesthesia level. The purpose of this study was to compare the effects of monitoring the BIS to not monitoring the BIS on time from discontinuation of GA to extubation and to discharge.

METHODS

Twenty-nine children were enrolled. BIS was monitored from admission until discharge. Each child received 0.7 mg/kg of oral Versed. In the operating room, GA with sevoflurane (IH), rocuronium 1 mg/kg (IV), fentanyl 1 microg/kg (IV), and ondansetron 0.15 mg/kg (IV) was administered. Randomly, in half the patients, the anesthesiologist maintained the level of anesthesia and BIS by adjusting sevoflurane. In the rest, the anesthesiologist did not know BIS. The time from turning off sevoflurane to discharge was compared.

RESULTS

Group 1 patients were extubated 5+/-2 minutes sooner than group 2 patients (P=.04). The post-anesthesia care unit stay for group 1 patients was 47+/-17 minutes compared to 63+/-17 minutes in group 2. (p=0.02).

CONCLUSIONS

Monitoring anesthesia with BIS promotes earlier extubation and discharge for pediatric dental patients who receive oral Versed and sevoflurane GA.

Probing the origins and control of shrinkage stress in dental resin composites. II. Novel method of simultaneous measurement of polymerization shrinkage stress and conversion

This study probes the interrelationships between polymerization shrinkage stress development and the polymerization progress with a novel experimental technique. This technique is capable of real time, simultaneous measurement of double-bond conversion and shrinkage stress with the use of a noninvasive near-infrared fiber-optic system, along with a cantilever beam-based tensometer. The results from both filled and unfilled bis-GMA/TEGDMA (70:30 mass ratio) systems showed that the shrinkage stress buildup was concentrated in the latter stages of polymerization, with its dramatic increase linked to the asymptotic approach of conversion to its limiting value. The monotonic increase of shrinkage stress with conversion in the vitrified state is attributed to the dramatic increase of the sample's elastic modulus during the vitrification stage and a certain amount of cooling stress as the sample cools down from the temperature rise caused by the exothermic polymerization and light absorption. Excellent reproducibility of both the polymerization kinetics assessment and the shrinkage stress measurement has been achieved.

The challenge of esthetic dentistry and elective services

Many dentists would like to increase the number of esthetic and elective procedures they perform. What may be holding them back is the ability to communicate with, educate and motivate patients in the area of esthetic and elective dentistry. While implants, esthetic dentistry or elective dentistry is not for every patient, each of these areas has improved the quality of many people's lives, allowing the dental profession to continue to serve the public in the broadest possible way.

Pretreatment wax-ups and provisionals for restorative dentistry

One of the most important factors in restorative success is the preparation of a case prior to treatment. Case planning, constructing the wax-up and provisional restorations, and understanding the potential problems with a case prior to beginning can only ensure a higher degree of success than would be achieved by not employing these basic restorative steps. Although it is not utilized generally, the wax-up can be of immense value to any restorative dentist for cases of all kinds, ranging from a single tooth to full-mouth reconstruction.

Research in general dental practice

Spurred by an initiative by the National Institute of Dental and Craniofacial Research in the USA, this article presents the need for a change in clinical dental research towards practice-based research. It outlines the shortcomings of past and present-day research in dentistry, with emphasis on the lack of clinical relevance of much of the research performed. The slow transfer of sound research findings to clinical practice is also a major problem. The article reviews some problems related to restorative dentistry and how they have adversely affected general dental practice. Practice-based research places emphasis on the problems experienced by clinicians in the routine care of patients. Clinicians should be linked together in research networks. The problems they face in dental practice and the clinical experience they have will form the basis for studies by the network. Experienced clinical researchers will provide guidance and statistical support for the studies initiated by the clinicians.

[Musculo-skeletal problems among Lebanese dental surgeons. Occurrence and risk factors]

OBJECTIVES

Search of factors influencing the occurrence of musculoskelettal problems (MSP) among Lebanese dental surgeons.

PATIENTS AND METHODS

Retrospective study, performed in September 2001. A 29 item-questionnaire exploring demographic and personal data, professional activity, the occurrence of musculoskelettal problems during the last month (MSPLM), and the twelve last months (MSPTLM) among Lebanese dental surgeons.

RESULTS

300 questionnaires--170 answers. Descriptive analysis--Age: 37 +/- 9 years; 141 men (83%); 96 general practitioners (56.5%); 93 (56%) practice sports ; stress: 94%; length of service: 12 +/- 8 years; duration: 7 +/- 1.75 hours per day and 5 +/- 0.75 days per week; breaks: 85 +/- 55 minutes per day; MSPLM: 66% ; pains: lumbar spine 85.5%, cervical spine 59%, shoulders and arms 62%, hands 10%, lower limbs 25%. Pins and needles: 32%; MSPTLM: 52.4%. Univariate analysis--Strong correlation for MSPLM occurrence with sports (p = 0.007), breaks duration (p = 0.005), occurrence of MSPTLM and current practice (general practitioners) p = 0.016. Multivariate analysis--Weight gain (p = 0.0119) x 6, history of MSPTLM (p = 0.000) x 21 and pins and needles (p = 0.0339) x 4,5 are the potential risk factors of MSPLM occurrence.

CONCLUSION

The prevalence of MSP is high in our series. The preventive and curative care is insufficient, thus information and prevention are necessary.

Periodontal plastic surgical indications in the restorative practice

A variety of advanced surgical techniques are available today for the treatment of soft-tissue complications in the restorative patient. Gingival recession and lack of attached gingiva can complicate delicate esthetic and prosthetic treatment. The restorative office must be able to critically evaluate the demands of the case and offer the patient options for correction of these advanced conditions. The ability to counsel in an informed way-outside the restorative arena-allows dentists to demonstrate their true commitment to the best outcome for the person they are dedicated to serve, the patient.

Oral rehabilitation under dental general anesthesia, conscious sedation, and conventional techniques in patients affected by cerebral palsy

The purpose of this report is to find the use of different alternatives for dental treatment, from general anesthesia to conventional techniques, in patients affected by cerebral palsy (CP) in a dental school setting. The sample was divided into two groups: (1) children, and (2) adolescents and young adults; 38 patients (20 female and 18 male) with diagnostic of CP were included. Risks and benefits of conscious sedation and general anesthesia were written into a consent form and these were discussed with parents or guardians of each affected patient. The mean age was 7.14+/-2.2 years for children's group and 18.5+/-3.06 years for adolescent and young adult group. Most children (77.3%) were classified as ASA II with a level of behavior I-II according to Frankl's scale and these patients were treated under general anesthesia (GA). For patients that were classified as of positive behavior with little necessity of dental procedures, independent of the medically compromised level, dental treatment was done with conventional techniques or with conscious sedation. Dental frequency procedures were as follows: composites, dental prophylaxis, and dental extractions in children; in adolescents and adults, important to point out is that in anterior teeth and molars endodontic treatment, and surgical procedures increased in frequency. The mixture sevoflurane-propofol worked well during pre-, peri-, and post-operative procedures. During the discharge process, most patients needed a recovery of 20-40 minutes after which they were awake and oriented, breathing comfortably with stable vital signs. It was concluded that GA with sevoflurane-propofol and conscious sedation are an excellent tool to provide dental treatment in CP patients in a dental school setting without most of the major postoperative complications, such as nausea and vomiting.

Erbium lasers in dentistry

Erbium hard tissue lasers have the capability to prepare enamel, dentin, caries, cementum, and bone in addition to cutting soft tissue. The ability of hard tissue lasers to reduce or eliminate vibrations, the audible whine of drills, microfractures, and some of the discomfort that many patients fear and commonly associate with high-speed handpieces is impressive. In addition, these lasers can be used with a reduced amount of local anesthetic for many procedures. Today, these instruments have evolved from their initial use for all classes of cavity preparations to their ability for removing soft tissue, their usefulness in the disinfection of bacteria within endodontic canals, and most recently, as an alternative to the high speed handpiece for the removal of bone in oral and maxillofacial surgery. In addition, recent research has centered on the value of the erbium family of laser wavelengths in periodontics, including the removal of calculus.

Multiple Testing to Establish Superiority/Equivalence of a New Treatment Compared with k Standard Treatments for Unbalanced Designs

In clinical studies, multiple superiority/equivalence testing procedures can be applied to classify a new treatment as superior, equivalent (same therapeutic effect), or inferior to each set of standard treatments. Previous stepwise approaches (Dunnett and Tamhane, 1997, Statistics in Medicine16, 2489-2506; Kwong, 2001, Journal of Statistical Planning and Inference 97, 359-366) are only appropriate for balanced designs. Unfortunately, the construction of similar tests for unbalanced designs is far more complex, with two major difficulties: (i) the ordering of test statistics for superiority may not be the same as the ordering of test statistics for equivalence; and (ii) the correlation structure of the test statistics is not equi-correlated but product-correlated. In this article, we seek to develop a two-stage testing procedure for unbalanced designs, which are very popular in clinical experiments. This procedure is a combination of step-up and single-step testing procedures, while the familywise error rate is proved to be controlled at a designated level. Furthermore, a simulation study is conducted to compare the average powers of the proposed procedure to those of the single-step procedure. In addition, a clinical example is provided to illustrate the application of the new procedure.

Are We Ready to Move from Operative to Non-Operative/Preventive Treatment of Dental Caries in Clinical Practice?

This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly 'caries free' when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not 'cure' caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.

The dental management of adult patients with haemophilia and other congenital bleeding disorders

The management of adult dental patients with congenital bleeding disorders has caused a considerable number of problems to the dental profession. There is a need to simplify the process and identify what can be safely carried out on a 'shared care' basis in General Dental Practice or the Community Dental Service. Particular problems are discussed with special reference to those requiring hospital care. The Scottish Oral Health Group for Medically Compromised Patients has developed this clinical guidance in conjunction with the Scottish Haemophilia Directors. It is important that dental care is easily available for this group of patients, especially those living at some distance from the regional centres. The aim is to simplify planning dental care for this group of patients and remove a number of myths concerning their management. The hospital departments, both medical and dental, must be available for advice and to arrange for treatment that is inappropriate outside a specialist hospital.

Differences between the Cerec-3D software versions 1000 and 1500

The Cerec-3D software was introduced officially at the IDS 2003 with the version 2.00 R1000. The decisive difference compared with the preceding software generations was that the prepared tooth and the restoration were displayed three dimensionally. Thus, the virtual changes which could be made with the aid of editing tools could also be controlled and seen immediately in 3D. The latest officially available version of the Cerec-3D software version 2.10 R1500 differs in some further developments from the first version 2.00 R1000; these are for example: --If the semiautomatic margin detector is switched off while marking the preparation margin, the alternative intensity image appears instead of the 3D display. --Designing has been decisively improved by the extension of the "Drop" tool (function of continuous application and removal of material). --Under morphologically difficult circumstances, the design proposal can be magnified/reduced in size and repositioned in all spatial directions. --The Parameter setting again permits setting an adhesive gap width specific to the dentist and unit. As an example, the version 1500 software is demonstrated on a simple clinical case in which the occlusion points were defined virtually with the aid of a functional bite registration, eliminating the need for occlusal grinding-in.

Status of current CAD/CAM technology in dental medicine

This article provides an overview of the status of current CAD/CAM technology and possible development trends. In addition to a description of the different CAD/CAM components required for producing computer-assisted dental restorations, innovative design methods recently introduced into dental technology are also mentioned. In the description of the practical application of the current CAD/CAM systems, the possibilities and limits of the present-day techniques and future outlook are illustrated. In this context, the current range of materials available for the computer-assisted production of biocompatible and at the some time high-quality dental restorations is also discussed. In conclusion, the different economic concepts coming into consideration in view of the high investment costs of the current CAD/CAM systems are presented and discussed.