Correlation between premature ejaculation and female vaginal penetration difficulties

Male and female sexual dysfunctions encompass biological, psychological and interpersonal aspects. Premature ejaculation (PE) and female vaginal penetration difficulties (VPD) are problems that may concurrently impair the couple's sexual relationship. We have studied the correlation between PE and VPD in the female partner, in a cross-sectional study of 125 heterosexual couples (male age 35.01±10.63; female age 32.36±10.07). VPD included tampon insertion, gynecological examination, inserting self-finger or partner-finger and penile-vaginal intercourse. Female sexual function index (FSFI) and a validated PE questionnaire were used to measure the female sexual function and PE in their male partners. We found that female partners of men with anteportal ejaculation were found to experience significantly more VPDs, especially with regard to difficulties in penile penetration and tampon use. The intensity of pain in VPD was higher in females whose male partners presented anteportal ejaculation. No significant correlation was found between total male PE score and the total FSFI or separate domains of female sexual function. The results suggest that female VPD and male anteportal ejaculation are interrelated. Such severe couple sexual problems should be addressed in parallel. Further research is required to study the causation of PE and VPD.

Sexual correlates of gagging and dental anxiety

OBJECTIVE

Both oro-related behavioural and sexual dysfunctions are non-life-threatening conditions which can have an impact on individual well-being. Possible common features include intra-body penetration, giving control to another person, and experiencing encounters that can sometimes be subjectively experienced as aggressive and/or abusive. The present study examined possible sexual correlates of dental anxiety and gagging.

BASIC RESEARCH DESIGN

A total of 448 individuals, who applied for sex therapy at the Sexual Medicine Center, Sheba Medical Center, Tel-Hashomer, Israel, completed the following sexual and dental functioning questionnaires: International Index of Erectile Function (men only), Female Sexual Function Index and difficulties with sexual penetration (women only), dental anxiety, gagging reflex and dentist preference (entire population).

RESULTS

Higher gagging reflex was associated with problems in sexual penetration and history of sexual abuse in women (especially one that included vaginal penetration). It was also associated with dental anxiety and higher preference for dentist of the same gender for both genders.

CONCLUSIONS

The study shows that gagging reflex can bear sexual connotations, especially in women.

Bruxism, oral parafunctions, anamnestic and clinical findings of temporomandibular disorders in children

The reported prevalence of temporomandibular disorders (TMD) present during childhood and adolescence ranges between 7% and 68%. The range of the reported prevalence of sleep bruxism in children is also wide. The purpose of the current study was threefold: (i) determine the prevalence of oral parafunctions, sleep bruxism and of anamnestic and clinical findings of TMD among Israeli children with primary or mixed dentition; (ii) to establish whether the parafunctional activities are associated with anamnestic and clinical findings of TMD in this population and (iii) to examine the possible impact of stressful life events on the prevalence of bruxism, oral parafunctions, and anamnestic and clinical findings of TMD in children. A total of 244 children (183 girls and 61 boys) aged 5-12 years were included in the study. Each participant underwent a full TMD examination. Parents, in collaboration with their children, completed a questionnaire on TMD symptoms, oral parafunctions and stressful life events in their children's life. Most participants (78·8%) reported at least one oral habit. Of these, only 'jaw play' was associated with TMD anamnestic and clinical findings. Stressful life events were associated only with the performance of multiple oral habits. These findings indicate that the performance of oral parafunctions is commonplace during childhood, with younger children exhibiting fewer oral parafunctions than adolescents. Stressful life events are related with an increase in the performance of multiple oral parafunctions in children but the later are not necessarily associated with anamnestic and clinical findings of TMD in the paediatric population.

Anxiety and Ability to Recognize Clinical Information in Dentistry

Stress significantly affects a person’s cognitive ability to process information. Therefore, we hypothesized that patients’ ability to recognize information related to the procedure they are about to undergo will be affected by the stressfulness of the situation (less recognition under a high-stress situation as compared with a low-stress situation). Patients (n = 66) were evaluated for their ability to recognize clinical information supplied on two different occasions: immediately before oral surgery (high-stress condition) and before suture removal (low-stress condition). Dental and state of anxiety and expectation of pain were also assessed. On both occasions, the patients’ ability to recognize information correctly was low (less than 50%). Patients recognized significantly less information pre-operatively than before suture removal. State of anxiety, dental anxiety, and expectation to experience pain had a profound effect on their ability to recognize provided information correctly. Apparently, before dental treatment (high or low on stress), patients’ ability to process information may be severely impaired.

Post-operative pain and use of analgesic agents in children following intrasulcular anaesthesia and various operative procedures

AIM

To characterise post-operative pain (PDP) and use of analgesic agents in children.

METHODS

The study consisted of 472 children, who received routine dental treatment. Teeth were anaesthetised by a computerised delivery system, either intrasulculary (CDS-IS) or by local infiltration (CDS-IF). Information regarding post-operative pain and use of analgesic agents was obtained by a telephone call within 24 hours after treatment.

RESULTS

The overall incidence of PDP was 38%. 60.9% of the children who experienced PDP were given an analgesic agent. Incidence and severity of pain were significantly associated with type of dental procedure. The highest incidence was found after root canal treatment (62.5%) and preformed crowns (60.8%). A higher incidence of PDP was found in teeth with history of pain or abscess as compared to teeth with restoration or caries (p <0.01). Incidence of pain was not associated with restoration material, extension, depth or type (occlusal vs proximal) of restoration, multiple restoration, gender, mode of CDS anaesthesia, or effectiveness of anaesthesia during dental treatment. Analgesic drugs were given mainly after preformed crowns, root canal filling and extractions.

CONCLUSIONS

PDP and analgesic use in children is common, especially after root canal filling, preformed crowns and extractions. CDS-IS is not associated with increased PDP.

An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students

OBJECTIVE

To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students.

DESIGN

Cross-cultural survey of dental students.

SETTING

18 cultural areas.

PARTICIPANTS AND METHODS

904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions.

RESULTS

The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001).

CONCLUSIONS

Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

[Severe limitation of mouth opening]

Limitation of mouth opening is a common source of referral to an orofacial pain clinic with a proposed diagnosis of Temporomandibular Joint Dysfunction (TMD). The word "trismus" is defined by the American academy of orofacial pain as: "Myospasm of masticatory muscles specifically causing limited jaw opening; early symptom of tetanus". Therefore, once trismus is suspected, TMD should be ruled out. However, it is not uncommon to find the usage of this term to describe severe limitation of opening by causes other than myospasm, therefore posing the risk of misdiagnosis. The purpose of this article is to describe the differential diagnosis of hard end limitation of opening with emphasis on the clinical tools used to differentiate between muscle source of hard end limitation and other sources of hard end limitation. Several cases of hard end limitation of mouth opening are presented and through them major principles of orofacial diagnosis are discussed.

Prediction of success and failure of behavior modification as treatment for dental anxiety

Behavior modification techniques are effective in the treatment of extreme dental anxiety, but their success is by no means absolute. In the present article, the Corah Dental Anxiety Scale (DAS), the self-report symptom inventory SCL-90R and a questionnaire accessing subjects' daydreaming styles (the Short Imaginal Process Inventory) were used to develop possible predictive measures for success and failure of behavior modification as a treatment for dental fear. The patients' level of distractibility and mind wandering, initial dental anxiety and somatization significantly predicted the success of therapy. The odds ratio indicated that the risk of therapy failure increased about 11 times with an increase of one scale of the Poor Attention Control Scale, about three times with an increase of one level of the mean DAS score, and 0.17 times with an increase of one level of somatization. The predictive value of the chosen scales was 80%. Thus, the use of these scales as part of an initial admittance process for patients who suffer from dental anxiety can enhance our ability to better recognize patients who are prone to fail behavior therapy as treatment for their problem, and enable their referral for other possible modes of treatment.

Modulation of dental anxiety — the role of past experiences, psychopathologic traits and individual attachment patterns

OBJECTIVE

To evaluate factors affecting modulation of dental anxiety among adults.

METHODS

A total of 183 adult members of a closed communal society (Kibbutz), who have been treated since childhood only by the dentists employed in their community, were investigated concerning their past and present dental anxiety, evaluation of their past and present dentists, psychopathologic symptoms and individual pattern of attachment.

RESULTS

The best predictor of subjects' evaluation of their present dental anxiety was the scale of anxiety as recorded by the SCL-90R questionnaire. The best predictors of the decrease in subjects' dental anxiety over time were the evaluation of their past and present dentists and the secure and avoidant patterns of attachment. Patterns of attachment (avoidant and ambivalent) were the best predictors of subjects' evaluation of their present dentist.

CONCLUSIONS

While psychopathologic traits are involved in subjects' present dental anxiety, pattern of attachment may have a dominant affect as to whether anxiety persists throughout life or can be modulated through a corrective emotional experience.

At first glance: social meanings of dental appearance

OBJECTIVES

An important factor in social interaction is physical appearance. Major elements in the evaluation of physical appearance are the mouth and teeth. The purpose of this study was to evaluate the effect of tooth appearance on the development of a first impression of the other person, with regard to the sex of both the respondent and the target.

METHODS

Eight facial photographs of individuals with intact upper teeth were manipulated: one set was left untouched and the other was professionally altered so that the front anterior teeth appeared decayed. The photographs were randomly aligned in sets of eight, each set consisting of four individuals with an original, intact dentition and four other individuals with a "decayed" dentition. The sets of photographs were then presented to 115 respondents (65 males and 50 females). Evaluations were made according to three categories of traits--esthetic, social, and professional.

RESULTS

For all three evaluation categories, the difference in scores between decayed and intact dentition given to targets were significantly higher when participants of one sex evaluated targets of the opposite sex, as compared to evaluating targets of their own sex.

CONCLUSIONS

The effect of tooth appearance on the physical attractiveness stereotype is more evident when males evaluate females and vice versa, rather than when evaluating their own sex.

Self-perception of breath odor

BACKGROUND

Bad breath, also known as halitosis, is a common concern for millions of people. Yet there is almost no reliable way for people to properly assess their breath odor. While many develop faulty perceptions about having bad breath that affect their entire lives, others who have halitosis are unaware of their condition.

OVERVIEW

The authors discuss the issues affecting self-perception of breath odor in patients who complain of halitosis, as well as in a more general, "noncomplaining" population. The article presents self-perception of breath odor as a multifactorial, psychophysiological issue that is related closely to one's body image and psychopathological profile.

CONCLUSIONS

Based on their data, the authors suggest that every patient has a breath odor self-image. This self-image ranges from little or no distortion to severe psychopathology. Because treating patients with a specific complaint of oral malodor primarily is the responsibility of the dental practitioner, several treatment approaches are outlined: collecting odor samples from the mouth to increase objectivity, involving a confidant in diagnosis and follow-up, corroborating odor judges' scores with objective measurements, increasing the patient's sense of control over the problem and obtaining guidance from mental health professionals, when necessary.

CLINICAL IMPLICATIONS

Dentists increasingly are being called on to help patients with complaints of bad breath. In diagnosing and treating such cases, dentists should consider psychological and physiological factors.

Topical application of capsaicin for the treatment of localized pain in the temporomandibular joint area

AIMS

To determine the effectiveness of topical capsaicin cream application on localized pain in the temporomandibular joint (TMJ) area.

METHODS

A randomized, double-blind, placebo-controlled study was conducted on 30 patients suffering from unilateral pain in the TMJ area. Patients were randomly divided into experimental and placebo groups; they were instructed to apply 0.025% capsaicin cream or its vehicle to the painful TMJ area 4 times daily for 4 weeks. Subjective parameters of present pain, most severe pain, effect of pain on daily activities, and pain relief were assessed each week on a visual analog scale. Muscle and joint sensitivity to palpation on the painful and contralateral joints and maximal mouth opening (assisted/passive and non-assisted/active) were examined weekly by the same experienced examiner.

RESULTS

Capsaicin cream produced no statistically significant influence on measured variables when compared to placebo. Both experimental and placebo groups showed statistically significant improvement in most variables during the experiment.

CONCLUSION

The factor of time had a major effect in the non-specific improvement of the parameters assessed. The placebo effect played an important role in the treatment of patients with pain in the TMJ area.

[Effect of professional training on dental health attitudes of Israeli dental students]

Few studies have been published regarding the importance of oral hygiene education for dental students and little is known about the influence of dental education in dental schools on students' attitudes to the subject. The objective of the present research was to examine the changes that occur in the attitudes of Israeli dental students toward their dental health during the course of their professional training. The research was based on a questionnaire developed at The Hiroshima University, Japan (The Hiroshima University Dental Behavioral Inventory, HU-DBI), and provides a quantitative estimate of the students' attitudes to their dental health. Similar studies have been carried out in several countries (Japan, Australia, Indonesia and Finland). This study was performed on students from the two dental schools in Israel, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University and The Faculty of Dental Medicine at Hebrew University, Jerusalem. Students from all six academic years (1st-6th) were requested to complete the questionnaire within two months, from the beginning of the academic year that started in October 1999. While no significant differences could be detected in the students' attitudes with regard to the dental school of their origin, female students (from both schools) showed a significantly better attitude than their male colleagues throughout the years. Results showed a significant improvement in the students' attitudes through the years of their professional training, especially between the 1st year and the clinical years (5th and 6th) of their studies. This can be related to the teaching curricula in the dental schools in Israel that emphasizes clinical issues in the two last years of study. When comparing the results of this study to similar ones that were conducted in other parts of the world, certain differences become apparent. In spite of the gradual improvement in the Israeli students' attitudes during the course of their studies, their initial attitudes (1st year) as well as their final attitudes (6th year), were the lowest compared to their colleagues from other countries (Japanese, Australian and Finnish students). Apparently, the improvement in the Israeli students' attitudes is not satisfying and a higher level of improvement should be expected. The attitudes of the Israeli students should be further improved by means of comprehensive programs that emphasize the importance of personal oral hygiene and dental health. Hopefully this will enable future improvement in the dental health of their patients, as well as improvement in the community dental health in Israel, in general.

Self-perception of breath odor: role of body image and psychopathologic traits

Oral malodor is a common complaint in Western society and is an important reason why adults seek dental counsel. In the present study, an attempt was made to evaluate the contribution of psychopathologic traits and of body-image char acteristics on participants' self-perception of breath odor. 60 participants without any specific complaint concerning breath odor (55% men: M age 35.5 yr., SD= 10) were evaluated. Variables included self-evaluation of participants' own breath odor (gener ally and current), an organoleptic evaluation of an impartial judge of odor, measurement of the volatile sulfide level in the oral cavity, and questionnaires referring to psychopathologic symptoms and body-image characteristics. Stepwise regression analysis showed that in addition to impartial measurements, self-perception of breath odor among noncomplaining subjects can be predicted by their feelings and attitudes toward the body and by their hostility.

Characteristics of adult dentally fearful individuals. A cross-cultural study

This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Goteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more 'active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more 'passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry.

Effect of gender on acute pain prediction and memory in periodontal surgery

Pain is a complex experience that is affected by factors such as gender, stress, anxiety and cognitions. The purpose of this study was to investigate the inter-relationship between gender and acute pain prediction and memory under periodontal surgery treatment. The study was conducted on 15 male and 22 female dental patients (mean age 34 yr, mean education level 14.7 yr), who were scheduled for periodontal surgery. Patients were evaluated during four consecutive appointments: at initial check-up, immediately pre-operatively, 1 wk post-operatively, and at 4 wk post-operative follow-up. Patients were requested to complete questionnaires concerning their anxiety at each appointment and to indicate their subjective evaluations concerning pain (on a visual analogue scale). Evaluations concerning expectation to experience pain during the planned surgery (pain prediction) were made at the first two appointments and evaluations of the experienced pain as remembered from the surgery (pain memory) were made at the last two appointments. Gender had a significant effect on pain prediction and pain memory. Men expected to experience more pain pre-operatively than women but remembered less pain post-operatively. It was concluded that cognitive pain perception in clinical situations differs between genders.

Continuous effect of pit and fissure sealing on S. mutans presence in situ

PURPOSE

The effect of sealants on S. mutans presence in situ was investigated.

METHODS

Four intact, fully erupted first permanent molars in each of 74 children, aged 6-8 years were required for inclusion in the study. Baseline examination included deft and plaque index. S. mutans presence on occlusal surfaces of the molars was evaluated, using a microbial replica method. Immediately after sealing the first permanent molars on one side, S. mutans presence in situ was re-evaluated, as well as three and six months thereafter. Three months after the initiation of the study, S. mutans presence was evaluated on the molars of the unsealed side, which were consequently sealed and re-evaluated immediately, and three months later.

RESULTS

Positive correlation was found between deft scores, plaque indices and microbial replica values, at baseline. Sealing caused a significant reduction in S. mutans levels on the treated occlusal surfaces, in vivo (P < 0.001), which lasted, in most cases, up to six months.

CONCLUSIONS

The data suggest that sealants enable a prolonged reduction of S. mutans presence in situ, indicating an additional prevention effect, by reducing one source of dissemination.

Effect of intended treatment on anxiety and on reaction to electric pulp stimulation in dental patients

Fear and anxiety are common emotional concomitants of acute pain that increase the perception of noxious events as painful. In the present study, 92 patients who were about to undergo various dental treatments (calculus removal, filling, root canal treatment, and extraction) were evaluated comparing the level of their dental anxiety and pain expectation from the intended treatment to their reaction to electric pulp stimulation. The data indicate that patients differ significantly in their dental anxiety levels and in their expectation to experience pain according to the following hierarchy (in descending order): extraction, root canal treatment, filling, and calculus removal. Anxiety and amount of pain expected from treatment correlated significantly with each other, but no simple correlations were found between anxiety and actual pain measures recorded after pulp stimulation.

Antecedents of dental anxiety: learned responses versus personality traits

The origins of dental fear and anxiety are numerous and complex. The purpose of the present study was to evaluate the relative effects of learned responses and subjective personality traits on the development of dental anxiety. The study was carried out in kibbutzim (closed homogeneous societies) in Israel where all subjects had received dental treatment from the same dentist since childhood with no choice of dentist. Subjects were requested to fill out questionnaires concerning their dental anxiety (DAS) in the past and at present, an evaluation of their dentist in the past and at present, and a psychopathologic symptom survey (SCL-90). The results show that dental anxiety at present correlates significantly with the evaluation of the present dentist; with dental anxiety as remembered from childhood; and with the following SCL-90 scales: interpersonal sensitivity, anxiety, phobic anxiety and Positive Symptom Distress Index. The best predictors of dental anxiety at present were the evaluation of the present dentist and past dental anxiety (as remembered from childhood). The results suggest that the level of the subject's dental anxiety is affected by environmental factors (evaluation of the present dentist, memories of anxiety from childhood), and by personality traits as evaluated by the SCL-90 questionnaire.

Interpretation of bitewing radiographs. Part 2. Evaluation of the size of approximal lesions and need for treatment

OBJECTIVE

The decision to treat initial approximal carious lesions is based mainly on interpretation of bitewing radiographs. In a previous report, it was shown that artificial approximal lesions of uniform size are more readily detected on radiographs in premolars than in molars. The objective of the present study was to compare the ability to evaluate the depth of similar size artificial lesions on radiographs and reach decisions concerning treatment, in premolars and molars.

METHOD

Clinicians were asked to evaluate on radiographs, the size of in vitro prepared artificial lesions, and decide at which point they would perform a restoration.

RESULTS

Significant differences were found in the evaluation of lesion depth between different tooth surfaces. The interaction between lesion depth and tooth surface originated from the examiners' trend to score same size lesions as penetrating deeper into the tooth in premolars than in molars. The probability of the examiners to decide on restorative treatment in shallow lesions (0.25 mm, 0.50 mm) was higher in premolars than in molars.

CONCLUSIONS

The findings suggest that clinicians evaluate initial lesions as being deeper and more prone to treatment in premolars than in molars.

Interpretation of bitewing radiographs. Part 1. Evaluation of the presence of approximal lesions

OBJECTIVE

Bitewing radiographs are the main tool for approximal caries detection. However, interpretation of findings is affected by numerous factors, such as beam angulation, exposure conditions, morphologic variations, etc. The objective of the present study was to compare the ability to detect virtually identical, artificial lesions in different tooth surfaces.

METHODS

The in vitro model included preparation and radiologic evaluation of approximal artificial lesions in premolars and molars in depths ranging from 0.00 mm to 1.50 mm.

RESULTS

Significant differences were found in the prospect of a lesion detection between the different lesion depths (p < 0.0000) and between the different surfaces examined (p < 0.05). The interaction between lesion depth and tooth surface was significant at the 0.0001 level (ANOVA with repeated measures).

CONCLUSIONS

The results indicate that initial approximal lesions of uniform size are more readily detected in premolars than in molars and that the chance of an incipient lesion to remain undetected is twice as high in molars than in premolars.

Reducing confirmation bias in clinical decision-making

Schematic, category-based thinking is a common approach to reduce uncertainty. Once the stimulus in question is categorized under a scheme, there is a tendency to look for features that fit the scheme. We have a tendency toward "positive testing" that is, to test instances we think will fit our hypothesis, paying less attention to those that will not (confirmation bias). Schematic, category-based thinking interferes with the process of decision-making in general and in medicine and dentistry in particular. To reduce schematic thinking and to avoid confirmation bias, one must acknowledge their existence. It is the task of dental educators to open the existing schemes and encourage broad, even controversial thinking that will focus on more than one hypothesis.

The complaint of oral malodor: possible psychopathological aspects

Oral malodor (halitosis) is a common concern in Western society. As with other human perceptions, emotional as well as cognitive variables play a major role in one's sensation and complaint. To study factors potentially associated with the complaint of oral malodor, periodontal and psychological evaluations were carried out on 38 subjects (66% female, mean age 43 years) with a complaint of oral malodor. Subjects underwent evaluation of their periodontal status, odor evaluation by an odor judge, and psychopathological symptom survey by means of the SCL-90 questionnaire. The patient's self-rating of oral odor was significantly higher than the evaluation of an objective odor judge and was not associated with their periodontal status. The SCL-90 profile of subjects was relatively higher than that of an age- and gender-matched reference group of dental patients. The results suggest that the complaint of oral malodor may be related to psychopathological symptoms as recorded by the SCL-90 questionnaire.

Antibacterial activity of three dental liners

PURPOSE

The purpose of the present study was to assess the antibacterial activity of the following three dental liners: Vitrebond (3M, St Paul, MN), Dycal (LD Caulk, Dentsply International, Milford, DE), and Life (Kerr, Romulus, MI).

MATERIALS AND METHODS

The test was based on a modification of the agar diffusion test in which samples were placed on agar plates previously inoculated with Streptococcus mutans and were removed after predetermined time periods. The material's effect on bacterial growth was evaluated.

RESULTS

Results show that Vitrebond has a strong antibacterial effect that was evident after 1 minute of direct contact with the inoculated bacteria. It was significantly more effective (P<.0001) than Dycal or Life.

CONCLUSIONS

This method allows for the evaluation of the antibacterial effect of dental materials.

Self-estimation of oral malodor

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-assessments prior to (preconception) and following (post-measurement) self-measurements; (ii) odor judge scores; (iii) dental-measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-oral trypsin-like activity. Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.

Effect of parapulpal pins on conservative restoration of pulpless premolars

Conservative restoration of pulpless premolars with composite resins is indicated in specific instances. The effect of parapulpal pins on marginal leakage and fracture resistance was evaluated in this in vitro study for composite resin restorations in 80 extracted, pulpless premolars. Conservatively prepared pulpless premolars restored with composite resin were resistant to occlusal forces and parapulpal pins were effective in reducing gingival marginal microleakage. Parapulpal pins significantly improved the marginal seal of composite resin restorations in pulpless teeth when the gingival margins of the restoration were placed in dentin.

Detection of psychopathologic trends in glossodynia patients

Glossodynia affects primarily middle-aged women. Although many possible etiologies have been proposed for the syndrome, most have not been substantiated. In the present study 56 glossodynia patients were evaluated for their psychopathologic profile as reflected by the SCL-90 questionnaire. The data show that glossodynia patients present a relatively high psychopathologic profile, especially on the scales of somatization and depression. Significant correlations were found between the intensity of pain experienced by the patients and some of the SCL-90 scales (somatization, depression, anxiety, GSI and PSDI). No correlations were found between SCL-90 scores and duration of symptoms, prevalence of symptoms per day and patient's condition during the past year. Patients living alone were found to differ significantly from those living with a significant other (overall group effect significant at the 0.01 level). The data suggest that psychopathologic trends may be associated with glossodynia.

Antecedents of burning mouth syndrome (glossodynia)--recent life events vs. psychopathologic aspects

Burning mouth syndrome--BMS (also known as glossodynia, glossalgia, glossopyrosis, or oral dysesthesia)--primarily affects middle-aged women. Many possible etiologies have been proposed to account for the syndrome; most are still unsubstantiated. One possible suggested etiology involves the presence of psychological components. In this study, 45 BMS patients and 45 age-, sex-, ethnic origin-, socio-economic status-, and education-matched control subjects were evaluated for their psychopathologic profile and existence of recent life events. All subjects were requested to complete the SCL-90 questionnaire and a Recent Life Changes questionnaire. The BMS patients scored significantly higher on all SCL-90 scales except one. A MANOVA test to evaluate the overall group effect was significant at the 0.0001 level. No differences between groups were found for recent life events. The data suggest that although BMS patients are subjected to elevated psychological stress, initiation of BMS symptoms is not necessarily correlated with stressful life events.

Dental anxiety: a cause for possible misdiagnosis of tooth vitality

Fear, anxiety and anticipation of pain are prepotent emotional and cognitive mediators of pain behaviour. As pain is often used as a parameter for evaluation of tooth vitality, existing dental anxiety may occasionally lead to possible misdiagnosis. A representative case is presented in which dental anxiety led to an initial misdiagnosis of endodontic pathology.

When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the "problematic" patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.

Correlates of success and failure in behavior therapy for dental fear

Extreme dental fear and avoidance are universal problems, with severe adverse effects on the patient's oral health. Although behavior modification techniques were shown to be effective in the treatment of this problem, their success is by no means absolute. In the present article, the SCL-90 questionnaire was used for development of possible predictive measures for success and failure of behavior modification as a treatment for dental fear. Patients who failed in treatment through behavior modification were found to score significantly higher on the global score of Positive Symptom Distress Index (p < 0.01) and on individual subscales of somatization (p < 0.02) and psychoticism (p < 0.05) than patients who were treated successfully. The predictive value of chosen SCL-90 scales was 71%. The results suggest that use of SCL-90 may be valuable for the prediction of success and failure of behavior modification as a treatment for dental fear and avoidance.

Halitosis measurement by an industrial sulphide monitor

Previous studies have established that hydrogen sulphide and mercaptans are the primary components of halitosis (bad breath). In the present investigation, we report a simple, rapid technique for measurement of halitosis-related sulphides. The technique is based on a portable instrument generally used for environmental safety applications. Seventy-five volunteers were measured using this technique, and the results (in peak ppb hydrogen sulphide equivalents) compared with organoleptic assessment by 7 judges. A highly significant overall correlation (r = 0.603; P less than 0.001) was obtained between these 2 methods. Moreover, in most cases, the organoleptic ratings of the individual judges correlated more highly with sulphide monitor values than with one another. The simplicity of the technique suggests its use in clinical studies as well as in diagnosis and treatment of patients with this complaint.

Hypnotic induction in dentistry--coping with the fear of losing control (autonomy): a brief communication

A common cause of stress among dental patients is the patient's fear of losing control in face of the "helplessness provoking" dental situation. Although hypno-relaxation and hypnosis serve as efficient tools to aid in the administration of dental treatment to such patients, some of them may view hypnosis as a further relinquishing of control to the hypnotist and thus resist hypnotic induction, despite their willingness to try to use hypnosis for therapeutic reasons. To avoid this resistance, a "self-control" induction method is suggested that enables the patient to remain in control throughout the process. This technique minimizes the threat of losing one's autonomy and thus enables treatment of these patients.

Wedges in restorative dentistry: principles and applications

Overhanging margins of proximal restorations are a well-known, iatrogenic cause of periodontal pathology. The high incidence of such findings in Western societies should arose the concern of the dental community. However, overhanging margins represent only part of the iatrogenic problem created by the misuse of wedges in restorative procedures. Other causes include incorrect proximal contouring, inadequate contact points and under- or overfilling the restorative material. The understanding of the variables associated with wedge selection and positioning has a major role to play in the prevention of iatrogenic periodontal pathology associated with restorative procedures. It is concluded that: (i) the occlusion of the matrix band to the remaining healthy tooth structure of the gingival cavosurface line angle should be achieved solely by the correct application of the wedges; (ii) the effect of the wedges on the proximal contour and contact area should be carefully re-evaluated prior to insertion of the restorative material; (iii) various sizes and shapes of wedges and a sharp knife for carving must be readily available.

Glass ionomer cement restorations: the effects of lasing the cavity walls on marginal microleakage

Glass Ionomer cements are used in modern dentistry for various preventive purposes, one of which is the treatment of cervical caries lesions. Anticariogenic properties and the ability to bond to dentin and enamel are their main advantages. Since acid-etching of the tooth prior to glass ionomer placement is contraindicated, a "dry" defocused laser beam was used to enhance retention. The results indicate that finishing the cavity walls with a laser beam increased the marginal microleakage of the glass ionomer cement restorations. Thus, the procedure was apparently found unsuitable for clinical use.

Identification of the rhamnose-sensitive adhesin of Capnocytophaga ochracea ATCC 33596

The coaggregation of the Gram-negative microorganism Capnocytophaga ochracea ATCC 33596 with several Gram-positive bacteria, including streptococci, actinomyces and rothia, is mediated by rhamnose-sensitive adhesin(s). In the present study, MAbs against the C. ochracea adhesin(s) were prepared. These antibodies inhibited all the rhamnose-sensitive interactions, indicating that they recognize epitopes at or near the rhamnose binding site of the adhesin. The monoclonals served as probes in immunoblot analysis and recognized a polypeptide of Mr 155 K present in the wild-type organism but absent in a coaggregation defective mutant. It is concluded that the rhamnose-sensitive interactions of C. ochracea are mediated by a 155 K Mr polypeptide present on its outer surface.

Effect of adhesive antibiotic TA on plaque and gingivitis in man

The adhesive antibiotic TA was applied to the dento-gingival junction of 8 human volunteers, suffering from moderate to severe gingivitis. 2 diametrically opposed quadrants of the mouth received 4 applications of 0.1 mg TA, while the other 2 quadrants were treated with a placebo and served as controls. The plaque index, gingival index and bleeding index were scored periodically for 2 weeks and in 4 patients for up to 30 days. The TA-treated quadrants showed a rapid decrease in all 3 indices following 2 treatments. A further improvement was observed with the 3rd and 4th treatments. 30 days after the onset of the experiment and 23 days after the last application, the indices were still considerably lower than the initial values.

Effect of the birth process on the neonatal line in primary tooth enamel

The neonatal line is a histologic landmark in primary tooth enamel corresponding to the event of birth. The average width of the neonatal line (NNL) in primary tooth enamel of 147 children was measured. In children with normal birth histories the width of the NNL was found to be 11.9 +/- 4.8 microns. It was wider (18.6 +/- 5.7 microns) in children born by difficult operative delivery and thinner (7.6 +/- 1.5 microns) in children born by Caesarean section. The data suggest that concomitant with the change from intrauterine to extrauterine environment, the birth process itself also contributes to the width of the NNL.

The plastic cap--an improved technique for impression taking

An improved impression technique is described using a plastic, transparent, flexible cap in combination with silicone impression materials. The technique can easily be applied at the chairside by the clinician and provides a solution to some of the present problems in impression with minimal trauma to the surrounding tissues.

Repair of an overcontoured cemented crown

A method for retracting gingival tissue to allow recontouring of crown surfaces and removal of overhanging margins has been presented.

Cell surface hydrophobicity of Actinobacillus actinomycetemcomitans Y4

Oral bacteria colonize the dento-gingival tissues in a selective manner. Hydrophobic reactions have been suggested as one of the major mechanisms of adhesion. Hydrophobicity of Actinobacillus actinomycetemcomitans Y4 (Aa) cells was studied in vitro using adherence to the liquid hydrocarbon, octane. Adherence of Aa cells to octane varied from 60-90%, depending on the medium in which they were grown, age of the culture and the buffer in which the assay was carried out. These data suggest that Aa is a hydrophobic bacterium, the hydrophobicity of which is expressed to a varying degree, and may have a rôle in its adherence to oral tissues.

Separation of amphipathic proteins based on adsorption to hexadecane:water interfaces

A method is proposed for the relatively simple and rapid separation of amphipathic biopolymers, based on adsorption onto and desorption from the surface of hexadecane droplets. Adsorption to the hexadecane:water interface was carried out by mixing hexadecane with aqueous protein solutions at room temperature. Desorption was performed by consecutive solidification and melting of the liquid hydrocarbon (m.p. 18 degrees C), resulting in coalescence of the droplets and reappearance of the desorbed moiety in the bulk aqueous phase. Of interest was the observation that lysozyme remains enzymatically active following this procedure.