Outpatient sedation for oral surgery. A new technique using etomidate

In an attempt to exploit the benefits and to reduce the incidence of side-effects of etomidate during intravenous sedation for nervous patients undergoing oral surgery under local analgesia, a series of four clinical trials were undertaken: a pilot study in which etomidate was preceded by a combination of pentazocine and diazepam; a double-blind study in which saline was randomly substituted for the etomidate, and two further studies in which the administration of etomidate was preceded by that of either pentazocine or diazepam alone. The combination of a small dose of diazepam (0.1 mg/kg) with an initial dose of etomidate (0.1 mg/kg) followed by increments of the latter as necessary proved to be most successful in reducing the severity of unwanted reactions while retaining the unique advantages of etomidate.

A retrospective study of microbiologic samples from oral mucosal lesions

This report describes findings in microbial samples from 271 patients with lesions of the oral mucous membranes. Analyses were made on the basis of direct microscopy and cultivation on nonselective and selective media incubated under aerobic and anaerobic conditions. Growth of bacteria was semiquantitatively determined according to a five-grade scale. Among the 134 samples for direct microscopy, fungi in yeast as well as hyphae phase, were identified in 39 cases. Among the cultivated samples, Candida albicans was detected in 107 cases, of which 71 were full-denture wearers. Staphylococcus aureus, coliform bacteria and Klebsiella were the most frequently isolated "nonoral" bacteria. In some cases also Streptococcus pyogenes, Haemophilus influenzae, Pseudomonas or other gram-negative aerobic bacteria were found. In 84 cases the bacteria mentioned were registered as single "nonoral" infection, and in 63 cases combinations of "nonoral" species occurred. In 51 of these 63 cases C. albicans was also involved. In 31 cases a significant quantitative increase of one or more oral bacterial species was registered. In 93 cases there was no indication of a microbial cause of the lesion. On the basis of these microbial findings, it might be presupposed that in the majority of cases microorganisms were of primary or secondary pathogenic importance to the lesions.

An evaluation of mechanical and adhesive properties of polycarboxylate and glass ionomer cements

Mechanical and adhesive properties of polycarboxylate and glass ionomer cements were studied. Water had an adverse effect on the compressive and tensile strengths of both materials. Both cements showed good bonding to enamel and dentine. Bonds between polycarboxylate cement and sterling silver were strong enough to cause cohesive failure of the cement rather than adhesive failure, when the specimens were tested. Surface cleaning and conditioning with 5% sodium hypochlorite solution showed an improvement in the bonds of the cements to dentine and they were significantly stronger than the bonds formed after the use of 50% citric acid solution (ASPA conditioner.)

Spontaneous fracture of an atrophic endentulous mandible treated without fixation

The positive clinical decision to treat a spontaneously fractured edentulous mandible passively depends on a careful evaluation of local and general factors pertaining. These include: (1) Preferably simple fractures with minimal displacement and an intact periosteal sheath. (2) Elderly and infirm patients and others in whom surgery is contra-indicated. (3) Case in which discomfort and inconvenience with fixation is likely to be worse than without, bearing in mind that fixation does not guarantee firm bony union and that many patients wear dentures and masticate successfully in the presence of complete failure of fragments to unite. It must be stressed that it is not suggested that this line of treatment be followed routinely, but that is is valid in certain selected cases.

Observation and comparison of polished composite surfaces with the aid of SEM and profilometer

Fourteen different composites were polished in vitro with Sof-lex 3M discs. The results were examined clinically, with SEM, and profilometrically. According to the clinical study the different materials were divided into three groups. Group A consisted of five composites, that could be polished up to a fair gloss. Group B contained five composites, where only a semi-gloss could be obtained. Group C contained four products, whose surfaces remained dull after whatever polishing procedure. The SEM study affirmed these results. The products of group A showed smooth and homogeneous surfaces; hence their name: smooth-surface composites. The products of group B can be considered as classic composites. Group C contains among others the glass ionomer cements. The profilometrical study pointed out that the roughness degree of group A was three times smaller than that of group B and five times smaller than that of group C. The polishing procedure was further analysed. Polishing material, technique and time are the most important factors in the finishing of composite fillings.

Viral hepatitis: a four-year hospital and general-practice study in Sydney 1. Epidemiological features, natural history, and laboratory findings

We studied 761 patients admitted to hospital with viral hepatitis between 1971 and 1974, and 53 patients with viral hepatitis seen in general practice in Sydney, following up some of them for one to two years. We evaluated factors contributing to each type of hepatitis. We noted differences in the patterns in hepatitis A, B and non-A non-B between Anglo-Saxon and non-Anglo-Saxon sectors of the community. All patients with hepatitis A regained normal liver function within 20 months of the acute illness. Of 115 hepatitis B patients seen at 12 months, 6% had chronic hepatitis Bs antigenaemia, 60% had developed anti-HBs antibodies, and 7.3% still had abnormal liver function. Of 20 non-A non-B patients followed for 12 months, liver function was still abnormal in three, but one of these had developed hepatitis B. The case fatality rate for the whole series was 0.66%.

Morphologic findings in dens evaginatus

10 specimens of dens evaginatus were partly examined by light microscopy, and by scanning electron microscopy. The morphological findings were consistent with the diagnosis of dens evaginatus although they indicated that the morphology of the evagination appears more complex than is seen in decalficied material alone. In two cases SEM revealed the existence of dental hard material within the evagination which in the other cases was filled out by necrotic pulpal material. This probable attempt of repair of the evagination is shortly discussed.

The use of an intermediate resin in the acid-etch procedure: retentive strength, microleakage, and failure mode analysis

Three composite resin systems, one conventional (Concise) and two microfilled (IsoPast and Silar), used with and without an intermediate resin (Concise Enamel Bond), were evaluated with and without thermal stress for in vitro retentive strength and sealing ability to acid-etched human enamel. All three materials yielded significantly different shear strength values. The use of an intermediate resin significantly improved both the shear strength and resistance to microleakage of Silar, while no differences were observed for Concise and IsoPast. The thermocycling procedure did not generally or consistently affect the results. The failure mode of the three acid-etched composite resins was studied by evaluation of the failure surface and by describing the percentage of enamel, composite, and interface which were present. The use of an intermediate resin did not significantly influence the failure mode, and the correlation between the failure mode and retentive strength, although significant was low. The study confirmed the importance of adequate wetting action of a resin on the etched enamel to ensure proper bonding.

Effect of two clasping assemblies on arch integrity as modified by base adaptation

(1) Altering clasp design can affect the way forces act on abutment teeth. (2) An RPI clasp design causes less distal displacement of the primary abutment tooth than circumferential clasp arms with a distal rest under the same conditions. (3) Forces applied on a mandibular distal-extension base will have a greater affect on the abutments on the same side of the arch than on crossarch abutments. (4) The influence of changes in clasp design is minimized when the bases are well adapted to the basal seat and fully extended.

Oral mucosa and complete dentures

The reduction in the epithelial thickness under dentures did not reach the level of significance. The significant reduction in the epithelial morphology indicating a flatter basement membrane would suggest that the epithelium undergoes an adaptive change as a result of surface loading to produce a more uniform epithelium. The degree of keratinization was less and the stratum corneum was thinner in the epithelium under dentures. The complete dentures in these studies seemed to reduce the quantity and quality of the keratin layer. This study has shown that the presence of a denture produced a more regular epithelium with few rete ridges, and a thinner, less highly keratinized stratum corneum.

Calcium, matrix polymers and plaque formation

This study explores the relationship between calcium ions, matrix polymers and the formation of natural plaque on the children's teeth, using direct observation, scanning, transmission and freeze-etching electron microscopy techniques. Plaques were observed either in situ or after removal from enamel with a chelating agent, EDTA. Plaque was not disrupted by EDTA. Matrix polymers in outer plaque were less abundant than in deeper layers of specimens exposed to EDTA before embedding. The several cationic electron-histochemical reagents used generally disclosed more matrix than routine contrasting. The various polymers, other than discrete structures such as fimbriae, may derive from saliva and gingival fluid as well as bacteria. It is concluded that calcium ions are of importance in the early phase of bacterial attachment to the host organic enamel integument, but that calcium plays no part in the formation or maintenance of the strong bonds that link organisms in established plaque.

Eruption of maxillary canines

In 79 of 124 children with bilaterally located widened follicles around non-erupted canines one of the maxillary canines was chosen by lot for surgical exposure of the tooth crown. In seven cases both maxillary canines were exposed. The remaining 38 children were radiographically controlled at certain time intervals as were the 86 cases where surgery was performed. The follicles removed from 52 cases were histologically examined. The result showed that surgical exposure did not enhance the eruption of the tooth. The histological examination showed that the histologic appearance of the extirpated follicle did not correspond to the radiographically verified width of the pericoronal space. The specimens were composed of a loosely arranged fibrous connective tissue with an epithelial lining occurring in 77% of the cases. The epithelial lining consisted of reduced enamel epithelium and showed in none of the cases squamous metaplasia or keratinization. Nor was there any clinical or histologic sign of a neoplastic or cystic change of the follicle.

Caries in primary dentition and social class in high and low fluoride areas

Of the two random samples studied, the first represented 6--8 year-old residents of a natural high fluoride area (n = 115) and resident of all other areas of Finland (n = 1219). The second sample was representative for 7--9-year-old children participating in public dental care in one Finnish country. Structured questionnaires were used to collect data on social class; caries diagnoses were made by local dentists in municipal dental clinics. Children in the highest social class had the lowest caries experience in both high and low fluoride areas. Differences between middle and lower social class children were small. Fluoride affected caries in the primary dentition similarly in all social classes; in both samples this was shown statistically by nonsignificant interaction between social class and fluoride. In Finland, differences between social classes in caries in the primary dentition cannot be removed solely by implementing water fluoridation.

Some considerations regarding the degradational interactions between mouth rinses and silver-soldered joints

For immersion tests with mouth rinses of Lavoris, Green Mint, and Cepacol, silver solders and silver-soldered stainless steel joints exhibited corrosive degradational reactions. Exposures to Lavoris resulted in the severest surface attack as followed by optical microscopy, scanning electron microscopy, and energy-dispersive x-ray microanalysis. This was confirmed by measurements of electrochemical potential and polarization. The cyclic voltammograms in Lavoris indicated a highly active corrosion potential of -0.94 v. sce, while potentials in Mint and Cepacol were only about -0.25 v. This activity is attributed to the presence of zinc chloride as the active agent in Lavoris, as well as the high zinc content (up to about 20 percent) and even higher zinc concentrations contained in copper-zinc microstructural phases of the silver solders and the ease for dezincification corrosive attack. Large increases in current above about -0.2 v. are observed with all rinse solutions as well as a prepared saliva substitute solution. The importance of toxicologic considerations of the agents released from silver solders and the interactions of corrosion with stress as factors in causing delayed failures of soldered joints are discussed. The presently available commercial solders without cadmium and zinc contents, but with higher fusion temperatures and decreased flow characteristics, are recommended for dental applications to increase the resistance to corrosion.

Treatment of temporomandibular arthropathy

The favorable spontaneous course of TMA indicates a conservation approach to treatment. One-half of the percent 119 patients were either not treated or treated by physiatric measures only. One-third of the patients were treated by pivotation, whereby TMJ pain was relieved within an average of 2 months. Pivotation seemed to prolong the spontaneous course of TMA. Steroids were injected intraarticularly in one-fifth of the patients, whereby TMJ pain was relieved within an average of 5 d. There were, however, symptoms other than pain that tended to persist after steroid injection. The various treatments did not result in any lasting differences in mandibular mobility. Pivotation and steroid injection seemed to result in a higher frequency of irregularity of the mandibular condyle as seem in transpharyngeal radiographs.

Effect of nonsterile versus sterile water irrigation with ultrasonic scaling on postoperative bacteremias

The contribution of nonsterile water irrigation during ultrasonic scaling to postoperative blood stream contamination was evaluated. Thirty human volunteers were subjected to a random split-mouth technique comparing sterile and municipal tap water irrigation with ultrasonic root preparation on contralateral mandibular quadrants. Scaling was performed by a single operator using a premeasured quantity of irrigant. Postoperative blood samples were obtained immediately and cultured aerobically and anaerobically in tryptic soy broth and on BHI agar plates for enumeration of colony forming units. Positive blood cultures were inoculated onto selective media for presumptive identification. The difference in the bacteremia incidence after scaling with sterile water (50%) versus scaling with tap water (53.3%) was not significant. The degree of the bacteremias (less than 1 colony forming unit/ml) was similar between groups. Therefore tap water irrigation used in ultrasonic scaling did not appear to be a significant causative agent in postoperative bacteremias.

Dental care for patients with renal failure and renal transplants

Patients with renal failure have characteristic systemic and oral conditions that require special precautions during dental treatment. Drugs must be administered with caution and patients undergoing hemodialysis must receive special consideration. Both hemodialysis and transplant patients must be protected against infection. This is achieved by early, aggressive, and thorough dental treatment. Use of antibiotics during dental treatment is essential in transplant patients and is often necessary in hemodialysis patients to protect them against bacteremia. Bacterial endocarditis is a concern in patients with renal failure and with heart disease and, in these patients, antibiotic prophylaxis is essential. Hepatitis is often present in patients with renal failure, and precautions should be taken against its spread. Before dental treatment of patients with renal failure is begun, the dentist should consult the patient's physician regarding specific precautions. A treatment plan should be constructed which best restores the patient's dentition and protects from potentially severe infection of dental origin.

Specificity of natural antibodies reactive with Streptococcus mutans in monkeys

Enzyme-linked immunosorbent assays were used to measure levels of natural antibody to defined antigens of Streptococcus mutans in sera from monkeys (Macaca fascicularis). The results suggest that most of the antibody in young monkeys that binds to whole bacteria is not specific to S. mutans.

Effects of fluoride and regular dental care on personal dental expenditures of young adults in Finland

This paper analyzes the relationship among presence of fluoride in the drinking water, oral health and dental expenditures in four towns in Finland. A two-stage least-squares model is used to determine the effect of fluoridated water and other independent variables on the number of missing teeth and per capita annual dental service expenditures for 555 adults. The results show that regularity of dental visits is the only significant factor explaining per capita expenditures. In contrast, many factors affect the number of missing teeth; most importantly, the number of dentists per capita, level of fluoride, age, education, use of services and smoking habits. These findings suggest that fluoride significantly improves oral health status but does not reduce adult per capita dental expenditures.

The rate of cervical abrasion in dental students

Abrasion of the cervical region of teeth has been attributed to mechanical cleaning procedures using dentisfrices containing abrasives of various kinds. In the present study the loss of substance during a 26 month period in the cervical region of the upper left premolars of dental students was measured directly by means of a micrometer. The average rate of abrasion was found to be 0.2 micro per day. No difference was observed between the group using a "non-abrasive" dentifrice and that employing a conventional paste. The risk associated with pulp exposure under the conditions observed is briefly discussed.

Two stage maxillary canine transplantation

Two case reports are described in which the two stage canine transplantation technique was found to be necessary in order to undertake orthodontic tooth movements in preparation of the transplantation sites.

Classical syndromes in occupational medicine: Phosphorus necrosis--a classical occupational disease

A disease nearly extinct in occupational health history is phosphorus necrosis, previously seen in near-epidemic proportions among workers making phosphorus-containing matches. Similar destructive lesions were encountered early in the 20th century among personnel fabricating fireworks. Through the diligent efforts of an economist and a supportive congressman, legislation was passed in 1912 placing a tax on phosphorus matches, and because of the fiscal burden resulting, a nontoxic substitute for elemental phosphorus was adopted by all manufacturers. Today phosphorus necrosis is extremely rare, but the former presence of the disease points up both apathy and courage in the identification and eradication of a remarkably disfiguring work-caused disease.

On intraoral potential- and polarization-measurements of metallic restorations. A methodological and time dependent clinical study

A study was conducted to scrutinize the precision of a method for in vivo potential and polarization measurements. The variation with time of the magnitude of currents created at contacts between metallic dental restorations of varying age was also studied. The precision found indicates that the method allows for comparatively precise measurements of potentials to be taken. Studies of performed measurements of polarizations show that the precision of these measurements varies somewhat with contact conditions and the areas of restorations examined. The precision of the currents calculated was found sufficient for precise enough calculation to be made of the magnitude of currents created in the oral cavity. The study also shows a decrease with time of the magnitude of currents created at contact between metallic dental restorations of varying age.

The surface finish of the new microfill restorative materials. A scanning electron microscope study

Surface smoothness is an important requirement for restorative materials. Recently, restorative materials claimed to be inherently smooth in surface characteristics have been developed. Matrix-formed and finished surfaces of five new microfill restorative materials were compared with two composite resins, an acrylic resin and a silicate cement by means of scanning electron microscopy. The results of this investigation indicated that the matrix-formed surfaces of all the restorative materials studied were not altogether perfect. Polishing using sandpaper and cuttlefish discs produced a very smooth surface finish in the new microfill restorative materials, Estic microfill, Estilux microfill, Isopast, Isolux and Silar which was comparable to that of the acrylic resin, Sevriton. The composite resins, Adaptic and Estilux exhibited the worst surface finish and the silicate cement, Bio-trey was intermediate. Finishing, using other finer polishing devices on four of the materials produced a further improvement in the surface finish.

The combined application of topical fluoride and fissure sealant--results after 2 years

The effectiveness of combining the application of topical stannous fluoride and fissure sealing using Nuva Seal was tested in a group of school children over a 2-year period. The retention rate of the applied sealant was 71.1%. The caries reduction after 2 years was 76.8% which appears to be slightly better than comparable studies using the sealant alone. Staining of the fissures, which may indicate an uptake of the applied fluoride by the tooth was also observed. Whilst the combined approach theoretically should provide additional protection from dental caries following the loss of the applied sealant, further observations are necessary to substantiate the hypothesis.

lontophoresis: Clinical Research in Musculoskeletal lnf lammatory Conditions

Fifty patients with various musculoskeletal inflammatory conditions were treated with iontophoresis (direct current 5 milliamperes, 20 minutes). The treatment drugs were 1 cubic centimeter, 4 milligrams per milliliter of dexamethasone sodium phosphate (Decadron) combined with 2 cubic centimeters of 4% Xylocaine. Thirty-eight of the 50 patients had an excellent relief of pain and symptoms, seven reported moderate relief, and five patients had little or no change. There were no significant side effects. It was concluded that iontophoresis is an effective mode of delivering ionized antiinflammatory drugs to inflamed tissues. It is effective, painless, and safe, and provides a viable treatment. J Orthop Sports Phys Ther 1982;4(2):109-112.