bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing caries risk in children
Authors: Messer Louise Brealey
Published: March 2008

With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions.
Indigenous Australian dental health: A brief review of caries experience
Authors: Martin‐Iverson Nicole , Pacza Tom , Phatouros Andrea , Tennant Marc
Published: March 2008

The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, fluoridation of water sources would be appropriate. In additioin, dental education programmes should receive high priority. As with the rest of the community, these preventive measures will result in less need for emergency dental treatment in the future, better oral health for the community and reduced financial burden on the State. It is under these circumstances that oral health planners and providers must, in consultation with the relevant community representatives, develop appropriate mechanisms to address the needs of this group. The development of strategies that integrate with the plethora of general health strategies currently being implemented is just one means of achieving improved oral health outcomes for indigenous Australians.
Caries experience among publicly‐funded dental patients in Australia, 1995‐96: Type of care and geographic location
Authors: Brennan D. S. , Spencer A. J. , Slade G. D.
Published: March 2008

Health card holders are a financially disadvantaged group and are the target population eligible for publicly‐funded dental care. While their health status is generally worse compared with other Australians, there is also considerable variation among card holders. The aims of this study were to describe the oral health status of publicly‐funded dental patients by type of care, geographic location and age, and to compare trends over time against other Australian studies. Patients were sampled randomly, based on date of birth, by State/Territory dental services in 1995‐96. Dentists recorded oral health measures at the initial visit of a course of care using written instructions, but there was no formal calibration. The 6109 patients sampled were weighted in proportion to the numbers of publicly‐funded dental patients for each State/Territory. Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p<0.05). For rural compared with urban patients, mean numbers of decayed and filled teeth tended to be higher. For emergency compared with non‐emergency care, mean numbers of decayed and missing teeth were higher, and filled teeth lower. The findings of this monitoring survey document high levels of previous disease and treatment and indicate variation between subgroups of users of publicly‐funded dental care. This included an uneven geographic distribution of oral health and disease, and variation in unmet treatment needs by type of course of care. Temporal comparisons indicate publicly‐funded patients have experienced the population trend towards lower levels of tooth loss over time but have higher levels of untreated decayed teeth compared with the general population.
Surgery combined with copper wire implantation in the management of cavernous orofacial haemangiomas
Authors: Ogunsalu C. , Fray D. , Lewis A.
Published: March 2008

This paper describes the management of a case of an extensive orofacial haemangioma by surgery combined with copper wire implantation. This technique of copper wire implantation in the management of orofacial haemangiomas was carried out for the first time in Jamaica by the authors. The use of percutaneous copper needles to induce therapeutic coagulation in cavernous haemangiomas, however, is not new, and this has been the basis of the use copper wire.
Conservative management of lower second premolar impaction
Authors: Collett Anthony R.
Published: March 2008

Lower second premolars account for approximately 24 per cent of impactions, excluding third molars, even though most reports in the literature relating to impacted teeth address the maxillary canine, with relatively few reports on the lower second premolar. Conservative management involves surgical exposrue of the crown, however, subsequent premolar eruption is unpredictable.

A case is described in which removel of a deciduous second molar was followed by eruption of an unfavourably inclined premolar located deep within the alveolus. Sufficient time must be allowed for eruption and in the present case 16 months elapsed before the tooth had erupted to the level of the occlusal plane.
Current concepts on functional appliances and mandibular growth stimulation
Authors: Collett A. R.
Published: March 2008

The mode of action of functional appliances, particularly in relation to stimulating mandibular growth, is a controversial subject. Many of the reports concerning growth effects of functional appliances have been characterized by poor methodology. In assessing functional appliances, results from prospective randomized clinical trials should be given prominence. On the basis of available evidence, it cannot be concluded that functional appliances are effective in stimulating and increasing mandibular growth in the long term. Although favourable growth changes have been reported following phase 1 therapy, they are generally not substantial and long term stability appears to be poor.
Potential of 4 per cent silver fluoride to induce fluorosis in rats: Clinical implications
Authors: Gotjamanos Theo , Ma Philip
Published: March 2008

The Health Department in Western Australia uses a 40 per cent silver fluoride (AgF) solution for prevention and treatment of dental caries in children. Analysis of this solution has revealed high fluoride concentrations (75,000–120,000mg/L), raising concerns of potential toxicity and prompting investigation of clinical protocols utilizing lowstrength AgF in an animal model. A single topical application of 4 per cent AgF solution to Sprague‐Dawley rats resulted in moderate to severe localized fluorosis in 24 per cent of animals. In a second experiment, caries was induced in rats aged 19 days; six weeks later, between one‐four carious molar teeth from each rat were treated with 4 per cent AgF (atraumatic technique). A generalized form of fluorosis developed in the continually growing incisors of less than 10 per cent of animals which had one or two carious teeth treated, and in 70–90 per cent of rats which received AgF to either three or four carious teeth. These results confirm the potential of a 4 per cent AgF solution to induce fluorosis and support previous recommendations that AgF at its empirical concentration of 40 per cent should be withdrawn from clinical use.
A late developing mandibular premolar supernumerary tooth*
Authors: Gibson Nova
Published: March 2008

This paper presents a case of a patient who developed a mandibular premolar supernumerary tooth between the age of 11 and 20 years. Evidence for the late development of the supernumerary tooth comes from consecutive panoramic radiographs. A review of the international literature concerning late developing supernumerary teeth is included.
Opinions of Dentists and Directors of Nursing Concerning Dental Care Provision for Adelaide Nursing Homes
Authors: Chalmers JM , Hodge C. , Fuss JM , Spencer AJ , Carter KD , Mathew R.
Published: March 2008

Background: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated.

Methods: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs).

Results: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practicerelated problems.

Conclusions: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy‐makers, administrators and nursing home staff.
Incidence and Aetiology of Facial Injuries Resulting from Motor Vehicle Accidents in Queensland for a Three‐year Period
Authors: Wood EB , Freer TJ
Published: March 2008

Background: No studies have been reported on the frequency and aetiology of facial injuries due to MVAs in Queensland. This study aims to investigate the incidence, aetiology, age and sex distribution of facial injuries resulting from MVAs for a period of three years.

Method: Cases were identified from the Motor Accident Insurance Commission, Queensland. Information including the type of injury sustained, the time, age and role of the patient in the accident were recorded and analysed.

Results: There was an average maxillofacial injury incidence of 4.8/100,000 per year, 53.5 per cent in males and 46.5 per cent in females. A peak incidence was found for both sexes aged 18 to 22 years. In males, 57 per cent of facial injuries occurred in this age group compared to 41 per cent in females.

Conclusions: Maxillofacial injuries as a result of MVAs are still relatively high regardless of the legislation for compulsory seatbelt use. Recent advances in seatbelt systems have the potential to reduce the risk of head and face impacts. The airbag is also well established as an effective means of preventing serious head and face injury. However, more research is required to further reduce the incidence of maxillofacial injuries as a result of MVAs.
Full occlusal protection—theory and practice of occlusal therapy
Authors: Darveniza Michael
Published: March 2008

In this review the full occlusal protection theory is proposed and its clinical practice demonstrated for varying Angle's malocclusions.

The concept of developing restorative anatomical shapes or bio‐designing occlusal schemes of crowns to compensate for poor intra‐arch tooth positioning is proposed and demonstrated.
Dental complications of head and neck radiotherapy: Part 1
Authors: Andrews Nectarios , Griffiths Chris
Published: March 2008

Radiotherapy for head and neck tumours is a viable treatment modality. However, a wide range of potentially debilitating dental complications may accompany this treatment. The nature and impact of these complications are outlined in this first part of a two‐part article. In Part 2, prevention and management strategies available to the dental practitioner to stave off the dental side effects of radiotherapy will be explored.
Cupped lesions of early onset dental erosion in young southeast Queensland adults
Authors: Khan F. , Young WG , Law V. , Priest J. , Daley TJ
Published: March 2008

Background: Dental erosion manifests as cupped lesions on cusp apices and in fissures of teeth in patients from southeast Queensland referred with excessive tooth wear. When found in young adults, these lesions may indicate early onset of active dental erosion. If the numbers and extent of cupped lesions increase with age, erosion may be a slow cumulative process.

Methods: This cross‐sectional study recorded the presence or absence and the relative sizes of cupped lesions from all cusps and occlusal fissures on premolar and permanent molar teeth from study models by image analysis. Type‐specimens of cupped lesions were examined.

Results: The incidence by tooth reflected time in the mouth, post‐tooth emergence. A linear increase in lesion number and size, with age, was found. However, cupped lesions occurred on mandibular first molar cusp apices as often, and attained greater extent, in adults under 27 years compared with older subjects.

Conclusion: Marked differences were found between lesion number and size, between maxillary and mandibular molar sites that reflect differences in salivary protection against dental erosion. The significance of this study is that the mandibular first permanent molar indicates the age of onset and severity of dental erosion
Prevalence of periodontal conditions among public‐funded dental patients in Australia
Authors: Brennan DS , Spencer AJ , Slade GD
Published: March 2008

Background: The aims of this study were to describe periodontal health status by gender, type of care, geographic location and age and to investigate associations of these factors with tooth loss.

Methods: In 1995‐96, state and territory dental services surveyed a random sample of 6,109 public‐funded patients. Dentists recorded oral health status at the initial visit of a course of care, using written instructions but without formal calibration. Periodontal status was assesed using the community periodontal index of treatment needs.

Results: Prevalence of periodontal conditions among dentate patients was higher among older, male, emergency and urban patients (X2; p<0.05). Age‐specific edentulism was lower for male, emergency and urban patients (X2; p<0.05). Numbers of missing teeth were lower for younger, non‐emergency and urban patients (Anova; p<0.05). Prevalence of periodontal pockets 6mm or more was assocated with gender, type of care, geographic location, age and number of missing teeth (logistic regression; p<0.05).

Conclusions: Prevalence of severe periodontal conditions was lower in 1995‐96 compared with public‐funded patients in 1984 and 1992‐93, but prevalence of periodontal health remained lower than the general population in 1987‐88. A survivor effect may result in lower recording of severe periodonatal conditions among subgroups with higher tooth loss.
Patterns of access to Public oral health care in Queensland by gender, indigenous status and rurality
Authors: Slater Penelope J.
Published: March 2008

Data were collected on courses of care from all attendances at public sector dental clinics between July 1994 and June 1996 and examined by gender, rurality and indigenous status. Males and indigenous people were more likely to attend dental clinics when a problem with pain existed, resulting in a high need for emergency services, more diagnoses of dental caries, and treatment more often involving oral surgery, including extractions. Similarly, remote area dwellers had more diagnoses of dental caries and oral surgery, although their attendance at clinics was complicated by access.
Ascending necrotising fasciitis as a result of odontogenic infection: a report of two cases
Authors: Shand JM , Breidahl A. , Hing NR , Johnstone BR , Wiesenfeld D.
Published: March 2008

Necrotising fasciitis is a severe soft tissue infection which spreads rapidly through fascial planes, is characterised by soft tissue necrosis and is potentially life‐threatening. It is a rare entity in the head and difficult and early diagnosis and aggressive surgical and medical management are essential. This paper reports two cases of necrotising fasciitis as a result of ascending odontogenic infection involving the temporalis muscle
Duties to the Patient and Beyond: Where is the Line Drawn?
Authors: LoK V.
Published: March 2008

The decisions in two recent Australian cases, emphasize the tendency for the Courts to place weight on the reliance of patients and others, to act on the advice provided by practitioners. In doing so, the duty of the practitioner to his or her patient has been extended to include third parties such as the patient's sexual partner and the patient's parents. Additionally, the decisions have shown that practitioners need to maintain a level of knowledge in the provision of advice expected of a professional as patients rely heavily on the information provided by the practitioners. This may include information that is available on the Internet.
Some Early Dental Extraction Instruments Including the Pelican, Bird or Axe?
Authors: Atkinson HF
Published: March 2008

This paper is the result of the cataloguing, preparation for exhibition and the study of some early dental extraction instruments. The artefacts included elevators, pelicans, keys forceps and pincers produced by unidentified makers or known firms. An evolutionary process is demonstrated from the simplest instrument leading to those used today. The naming of the artefacts follows a path relating to their method of use and to their appearance in regard to common everyday objects and animals or their parts. All were found to exhibit this association except the pelican which did not fit its long held position.
Morphological Study of Demineralized Dentine After Caries Removal Using Two Different Methods
Authors: Sakoolnamarka R. , Burrow MF , Kubo S. , Tyas MJ
Published: March 2008

Background: Caries‐affected dentine is the usual substrate bonded to in everyday clinical practice. The first step for most of the current dentine adhesive systems is etching or conditioning. It is therefore important to understand the effect of etchant/conditioner on caries‐affected dentine.

Methods: Twelve extracted carious permanent molars were examined. Six teeth had caries removed using burs after staining with a caries detector dye, and caries from the other six was removed using CarisolvTM. After caries removal, three teeth from each group were left untreated. The remaining teeth were sectioned to obtain two normal dentine samples and two caries‐affected dentine samples from each tooth. One half of the normal dentine samples and one half of the caries‐affected dentine samples were treated with 35 per cent phosphoric acid, and the remaining samples were treated with 20 per cent polyacrylic acid/3 per cent aluminium chloride. The samples were observed using field emission scanning electron microscopy (FE‐SEM).

Results: Phosphoric acid treated samples showed more obvious intertubular dentine microporosity and greater depth of demineralization in caries‐affected dentine. Polyacrylic acid treated samples showed some residual smear layer. However, the peritubular and intertubular collagen network was easily observed in CarisolvTM treated dentine. The depth of demineralization was not as distinct as that of the phosphoric treated samples.

Conclusions: From this study it was shown that etched ‘normal’ dentine and etched caries‐affected dentine had different surface appearances. Furthermore, the two caries removal techniques resulted in different caries‐affected dentine surfaces after acid treatment that may influence the longevity of bonds from adhesive restorative materials.
The Prevalence and Experience of Oral Diseases in Adelaide Nursing Home Residents
Authors: Chalmers JM , Hodge C. , Fuss JM , Spencer AJ , Carter KD
Published: March 2008

Background: The twenty‐first century will see the evolution of a population of dentate older Australians with dental needs very different from those of older adults in past years. This study provided comprehensive information concerning oral disease prevalence in older South Australian nursing home residents.

Methods: This paper presents cross‐sectional baseline results.

Results: Most of the 224 residents, from seven randomly selected nursing homes, were functionally dependent, medically compromised, cognitively impaired and behaviourally difficult older adults who presented many complex challenges to carers and to dental professionals. Two‐thirds (66 per cent) were edentulous with many dental problems and treatment needs. Dentate residents had a mean of 11.9 teeth present, higher than previously reported. The prevalence and experience of coronal and root caries and plaque accumulation was very high in dentate residents; especially males, those admitted more than three years previously, those who ate fewer food types and those who were severely cognitively impaired. These residents had more retained roots, decayed teeth and missing teeth, and fewer filled teeth when compared with data for community‐dwelling older adults.

Conclusions: This study highlighted the poor oral health status of these nursing home residents and the great impact of dementia on their high levels of oral diseases.
Mandibular Fracture Patterns in Tasmania, Australia
Authors: Dongas P. , Hall GM
Published: March 2008

Background: No previous studies on mandibular fracture patterns in Tasmania, and very few elsewhere in Australia, have undertaken to discover which identified age, gender, aetiology, anatomical location of the fracture, period of injury, whether alcohol consumption was associated with the injury, and treatment of mandibular fractures.

Method: A retrospective study was undertaken of 251 patients with fractured mandibles presenting to the Royal Hobart Hospital, Tasmania from 1993–1999. Data were obtained from the Oral and Maxillofacial Surgery unit fracture record books cross‐checked with patients, impatient/outpatient hospital records.

Results: The male to female ratio was 4.5:1, with mandibular fractures most common in the male age group of 21–30 years. Assaults (55 per cent of all patients) were the major cause of fractures. Males accounted for 85.5 per cent of assaults, with punching being the most common method, followed by motor vehicle accidents (MVA), 18.3 per cent and sport, 16.7 per cent. In sport, Australian Rules Football was the most common cause, accounting for 45.2 per cent of sporting injuries. The site most frequently fractured was the angle of the mandible. Alcohol abuse was seen in 41.4 per cent of the patients with 84.6 per cent being male. Open reduction and internal fixation with miniplate osteosynthesis, was the preferred treatment modality. The results are compared with other series.

Conclusions: Mandibular fractures are common in Tasmania, with the highest rates involved in assaults and sport (especially Australian Rules Football) and a low rate in MVA. These fractures commonly occurred in young males in which assaults, alcohol and social issues were associated. Therefore, preventive measures and strong public awareness addressing this group may be of benefit in reducing the rate of assaults and sporting injuries to the mandible.
Dentists, Diabetes and Periodontitis
Authors: Bjelland S. , Bray P. , Gupta N. , Hirsch R.
Published: March 2008

This review updates the relationship between diabetes mellitus and periodontitis. A checklist has been included to assist the general dental practitioner identify individuals with undiagnosed diabetes. The literature indicates a similar incidence of periodontitis exists between well‐controlled diabetics and non‐diabetics. However, a greater incidence and severity of periodontitis is observed in both Type 1 and 2 long‐term diabetics with poor metabolic control. There is an undeniable link between diabetes mellitus and periodontitis with complex interactions occurring between these diseases. A critical review of the literature fails to support the notion that periodontal therapy has a beneficial effect on the long‐term control of diabetes. We have explored the associations between periodontitis and diabetes in the hope of providing the general dental practitioner with the knowledge to support the diabetic patient with the best possible dental care and advice.
Acidic Diet and Dental Erosion Among Athletes
Authors: Sirimaharaj V. , Messer L Brearley , Morgan MV
Published: March 2008

Background: The consumption of acidic foods and drinks is increasing in popularity. The purposes of the present study were to investigate the consumption patterns of acidic foods and drinks among several sport groups and to examine any relationships between consumption patterns and dental erosion.

Methods: A questionnaire of oral health habits, diet and dental health was developed. Thirty‐two sports clubs (690 members) of the University of Melbourne participated in a survey. A total of 508 usable questionnaires were received (74.9 per cent response). Descriptive statistics were prepared and logistic regression was used to explore relationships between dental erosion (dependent variable) and the independent variables.

Results: Dental erosion was reported by 25.4 per cent of respondents, particularly among athletes of the Martial arts (affecting 37.4 per cent). The consumption of acidic foods and drinks was frequent among most athletes. No significant associations were identified between dental erosion and the frequency of drinking soft drinks or sports drinks. Statistically significant associations were found between dental erosion and age group (p=0.004), frequency of drinking juices (p=0.05), and tooth sensitivity (p=0.001).

Conclusion: Athletes may be placing themselves unintentionally at risk of dental erosion and dentists could counsel athletes to control and reduce the effect of potentially erosive foods and drinks.
Studies on dental erosion: An in vivo‐in vitro model of endogenous dental erosion‐its application to testing protection b flouride gel application
Authors: Jones L. , Lekkas D. , Hunt D. , McIntyre J. , Rafir W.
Published: March 2008

Background: The objective in this study was to develop an in vivo‐in vitro model of endogenous erosion, with a view to exploring the potential for some degree of its control by the use of topical fluoride gel application to teeth.

Results: The depth of erosive demineralization of enamel was found to be greatly reduced with increased frequency of APF gel application. The reduction in enamel loss was less following topical application of NaF gel.

Methods: Six volunteers each wore a small clasp retained palatal acrylic appliance to which six sterilized enamel tiles were bonded. Three tiles on each appliance were coated extra‐orally with either 1.23 per cent acidulated phosphate fluoride (APF) or 2.2 per cent sodium fluoride (NaF) neutral gel for four minutes prior to multiple periods of exposure to the simulated gastric acid, cumulating in 16, 36, 80 and 150 minutes of exposure. Impressions of the enamel tiles prior to and following acid exposure permitted dies to be prepared. These were sectioned through the exposed areas and examined under a stereomicroscope to assess maximum depths of erosion.

Conclusions: It was concluded that fluoride gels significantly reduced enamel erosion using this in vivo‐in vitro model and therefore, if prescribed appropriately, should help reduce tooth tissue loss from endogenous erosion.
Tongue cancer: Do patients younger than 40 do worse?
Authors: Hyam DM , Conway RC , Sathiyaseelan Y. , Gebski V. , Morgan GJ , Walker DM , Veness MJ
Published: March 2008

Background: Debate continues as to whether being young confers a worse prognosis for patients with squamous cell carcinoma of the tongue. Recent papers have provided conflicting views in this debate. In this study we aimed to investigate if young age at the time of diagnosis of squamous cell carcinoma of the tongue confers a worse prognosis.

Methods: Eligible patients were identified through the computer database of the Department of Radiation Oncology, Westmead Hospital, Sydney. All eligible patients were treated with radical intent. Using age 40 as a cut off multivariate and survival analysis was undertaken to compare age groups.

Results: Median age at diagnosis was 60 years (range, 19–86 years) in 84 males (65 per cent) and 45 females (35 per cent). Median follow‐up time was 43 months (range, 2.3–203 months). Fifteen patients (12 per cent) were aged <40 years. On univariate analysis stage and age were significant determinants of disease‐specific survival. There was no difference in overall survival between the young (<40 years) and middle‐aged groups (40–60 years). However, the young and the middle aged were both more likely to survive than the older age group (>60 years). On multivariate analysis age remained a significant factor for determining disease‐specific survival, with the older age group 2.9 times more likely to die than the younger groups.

Conclusion: Young age (<40 years) did not portend to worse survival in comparison to older tongue cancer patients.
Implant‐supported titanium prostheses following augmentation procedures: A clinical report
Authors: Knabe C. , Hoffmeister B.
Published: March 2008

Background: This report describes a novel technique for fabricating retrievable implant‐supported titanium (Ti) prostheses in patients requiring a comprehensive treatment plan involving the combined efforts of maxillofacial surgery and implant prosthodontics.

Methods: Following bone graft reconstructive surgery and implant placement prosthetic treatment was initiated by inserting ITI‐Octa abutments. An impression was made, and a framework was fabricated by fusing Ti‐cast frameworks to prefabricated titanium copings by laser‐welding. This was followed by veneering or fabrication of a removable denture with Ti metal re‐inforcement.

Results: Favourable clinical results have been achieved using these screw‐retained Ti implant‐supported restorations for patients treated with reconstructive bone graft‐surgery, with clinical observation periods ranging from three to four years.

Conclusions: The present observations suggest that these screw‐retained implant‐supported Ti prostheses may be a meaningful contribution to implant prosthodontics, facilitating retrievable restorations of optimum biocompatibility, good marginal precision and with a good esthetic result. However, controlled clinical studies are needed to establish the long‐term serviceability of these Ti restorations.
Current concepts of the management of dental extractions for patients taking warfarin
Authors: Carter G. , Goss AN , Lloyd J. , Tocchetti R.
Published: March 2008

Background: Controversy has surrounded the correct management of patients therapeutically anticoagulated with warfarin who require dental extractions. The risk of bleeding must be weighed up against the risk of thromboembolism when deciding whether to interfere with a patient's warfarin regimen. An improved understanding of the importance of fibrinolytic mechanisms in the oral cavity has resulted in the development of various local measures to enable these patients to be treated on an outpatient basis.

Methods: A review of the literature was undertaken. This was supplemented by the authors' clinical trials and extensive clinical experience with anticoagulated patients.

Results: Various protocols for treating patients taking warfarin have been reviewed and summarized and an overview of the haemostatic and fibrinolytic systems is presented. A protocol for management of warfarinized patients requiring dental extractions in the outpatient setting is proposed.

Conclusions: Patients therapeutically anticoagulated with warfarin can be treated on an ambulatory basis, without interruption of their warfarin regimen provided appropriate local measures are used.
The role of occupational stress in the maladaptive use of alcohol by dentists: A study of South Australian general dental practitioners
Authors: Winwood PC , Winefield AH , Lushington K.
Published: March 2008

Background: It is well recognized that dentistry is a stressful profession. However, there are conflicting views about the extent to which such stress contributes to hazardous drinking among dentists. In addition, the relative contributions of stress and pre‐existing vulnerability in predicting alcohol problems among dentists generally (and Australian dentists in particular) have yet to be determined.

Methods: The levels of stress and alcohol consumption of 312 South Australian dentists were measured. Factors known to mediate vulnerability to alcohol disorders were also assessed with appropriate psychometric instruments.

Results: High levels of stress/burnout, consistent with other studies of dentists' stress, were recorded. Hazardous levels of alcohol consumption, which were between two and four times higher than the normative South Australian population, were also reported, particularly among males and rural dentists.

Conclusions: To a significant extent, stress and hazardous alcohol consumption are both present among South Australian dentists. However, compared with work stress/burnout, existing personal vulnerability factors are much stronger predictors of such hazardous alcohol consumption. We suggest that professional dental bodies, and state Dental Boards, may play a role in ensuring stress inoculation and guidance on safe limits of alcohol consumption for dentists‐in‐training; and in creating appropriate mechanisms for assisting dentists who experience alcohol related difficulties.
Microtensile bond strengths to caries‐affected dentine treated with Carisolv
Authors: Burrow MF , Bokas J. , Tanumiharja M. , Tyas MJ
Published: March 2008

Background: Little information is available regarding the bonding performance of adhesive restorative materials to caries‐affected dentine after the use of Carisolv(r). The aim of this study was to compare the microtensile bond strengths of two resin‐based adhesives, a conventional glass ionomer cement and resin modified glass ionomer cement to ‘normal’ dentine and caries‐affected dentine after Carisolv treatment.

Methods: Specimens were prepared using molar teeth with small carious lesions. Caries was removed with the Carisolv(r) solution and the whole surface was bonded with either SE Bond, One Coat Bond, Fuji IX or Fuji II LC. After 24 hours, specimens were prepared for the microtensile bond strength test and stressed in tension at 1mm/min until rupture of the bond. Mean bond strengths and mode of failure were determined and analysed with the LSD test and chi square test respectively.

Results: The results showed no statistical difference for SE Bond, One Coat Bond or Fuji IX, but a difference was observed for the resin‐modified GIC, Fuji II LC.

Conclusions: It was concluded that carious dentine treated with Carisolv did not affect the adhesion of the adhesive restorative materials tested in this study with the exception of Fuji II LC.
Clinical evaluation of an ‘all‐in‐one’ bonding system to non‐carious cervical lesions—results at one year
Authors: Burrow MF , Tyas MJ
Published: March 2008

Background: The recent trend in using dentine adhesives is to simplify the number of steps required for bonding. The simplest are now the so‐called ‘all‐in‐one’ products which combine the etching, priming and bonding steps into a single application. However, few clinical trials have been reported using this type of material. The current study reports the one‐year results of a clinical trial with One‐Up Bond F and Palfique Estilite resin composite.

Methods: Fifty‐one non‐undercut non‐carious cervical lesions were restored with One‐Up Bond F and Palfique Estilite in 15 patients (mean age 57.5 years). Restorations were evaluated at six months and one year for presence or absence and for marginal staining using standardized colour photographs for comparison.

Results: At one year, 42 restorations could be evaluated and all were intact. Slight marginal staining was observed around three restorations but was considered to be of no clinical significance.

Conclusions: One‐Up Bond F with Palfique Estelite shows good promise for the restoration of non‐carious cervical lesions.
The split denture: A new technique for artificial saliva reservoirs in mandibular dentures
Authors: Mendoza AR , Tomlinson MJ
Published: March 2008

Xerostomia is a relatively common complaint that can make the wearing of dentures very uncomfortable for affected individuals. To help overcome this problem, a number of techniques have been proposed for incorporating reservoirs, containing salivary substitutes, into dentures. These have had varying degrees of success. This paper presents a case of a patient suffering from xerostomia who was successfully treated with a new form of reservoir denture. This new split‐denture technique resulted in a reservoir denture that provided good lubrication of the oral tissues, was easily cleaned by the wearer and was produced from routine denture materials. Details of its design, construction and other potential applications are also presented.
Non‐surgical management of an oro‐antral fistula in a patient with HIV infection
Authors: Loean RM , Coates EA
Published: March 2008

Background: The risk of post‐extraction complications is higher in patients who are immunosuppressed compared to other patients with normal immune function. In addition, invasive dental procedures are more likely to have serious complications in these patients. This case report demonstrates an effective non‐surgical procedure to treat an oro‐antral fistula in an HIV‐infected man.

Methods: The oro‐antral fistula was de‐epithelialized under local anaesthesia and the patient wore a surgical splint continuously, removing it only for cleaning, for an eight week period. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oro‐antral communication. The patient was reviewed on a regular basis.

Results: This procedure resulted in resolution of the patient's symptoms within two weeks. Complete healing of the oro‐antral fistula was evident following eight weeks of wearing the surgical splint.

Conclusions: This procedure provided an effective method of treating an oro‐antral fistula in an immunocompromised patient without causing any detrimental effects to the patient's overall health. Adequate pre‐surgical assessment of patients prior to extractions is important in all patients to help prevent the occurrence of such complications.
The human lateral pterygoid muscle: A review of some experimental aspects and possible clinical relevance
Authors: Murray GM , Phanachet I. , Uchida S. , Whittle T.
Published: March 2008

The clinical notion that some disturbance to the activity of the lateral pterygoid muscle plays a role in the aetiology of temporomandibular disorders (TMD) is still widely accepted and influences management strategies. However, there is no rigorous scientific evidence to support this clinical notion and the role of the lateral pterygoid muscle in normal function is still controversial. The classically defined functions of each head of the muscle are that the superior head is active on closing, retrusion, and ipsilateral jaw movements, while the inferior head is active on opening, protrusion and contralateral jaw movements. However, recent data indicate that these concepts are too simplistic. For example, recent evidence suggests that parts of the superior head may also be active on opening, protrusion and contralateral jaw movements, and that the superior head may consist of three mediolaterally arranged functional zones. Given these complexities, the proposal that clicking and/or locking conditions arise in the temporomandibular joint through some form of lack of co‐ordination between the two heads of the muscle needs re‐evaluation. Despite earlier reports to the contrary, both heads of the lateral pterygoid muscle appear to be electrically silent at the postural or resting jaw position, and therefore appear to play no role in the anteroposterior positioning of the jaw at the postural position. An important role has also been demonstrated electromyographically for progressive changes in activity in the inferior head as the direction of horizontal jaw force shifts from one side to the other. This suggests an important role for the lateral pterygoid muscle in the generation of side‐to‐side and protrusive jaw forces. The lateral pterygoid muscle is likely therefore to play an important role in parafunctional excursive jaw movements and also possibly a role in influencing jaw position in patients where the maxillomandibular relationship records change from session to session. The above data provide new insights into the normal function of the lateral pterygoid muscle. The proposal that the lateral pterygoid muscle plays some role in the aetiology of TMD needs now to be rigorously tested.
Non‐surgical approach to advanced chronic periodontitis: A 17.5‐year case report
Authors: Kawamura M. , Sadamori S. , Okada M. , Sasahara H. , Hamada T.
Published: March 2008

This 17.5‐year longitudinal case report details the treatment of advanced chronic periodontitis in a female patient commencing at 34 years of age. The woman was provided with periodontal care comprising of temporary fixation, scaling and root planing, intra‐pocket irrigation using a root canal syringe and regular supervised maintenance. The patient presented with a 10‐year history of bleeding gums. Therapy conducted in general practice had included simple curettage and irrigation. However, these treatments proved unsuccessful and the patient often changed dentists seeking better treatment. She presented to the University Dental Hospital, for diagnosis and treatment of her periodontal conditions after her mandibular lateral incisor had exfoliated. On presentation a purulent exudate could be expressed from all of the pockets. All anterior teeth, excluding the maxillary canines, demonstrated +2 to +3 mobility. The patient did not want any surgical treatment or her teeth extracted. It was decided to treat the patient conservatively without surgery. By postponing extraction, the authors were in a better position to determine the prognosis of the remaining teeth after the infection was under control. Although six teeth were extracted during the 17.5 years, this case report suggests that a non‐surgical approach is a viable option while maintaining regular visits for periodontal care.
Psychic and occlusal factors in bruxers
Authors: Manfredini D. , Landi N. , Romagnoli M. , Bosco M.
Published: March 2008

Background: The aim of this study was to investigate the existence of associations between bruxism and psychic and occlusal factors.

Methods: Participants in this study (n=85) were recruited from the Section of Odontostomatology, Department of Neuroscience, University of Pisa, Italy. They were split into two groups, bruxers (n=34) and non‐bruxers (n=51), on the basis of the presence of both clinical and anamnestical indicators of bruxism. All participants were administered two self‐reported validated questionnaires to evaluate mood (MOODS‐SR) and panic‐agoraphobic (PAS‐SR) spectra. A number of occlusal variables (deep‐bite, cross‐bite, open‐bite, mediotrusive and laterotrusive interferences, slide RCP‐ICP, laterotrusive guides, canine and molar classes) were also recorded.

Results: With regards to occlusal factors, the only association was revealed between bruxism mediotrusive interferences (p<0.05). As for psychiatric investigation, significant differences between bruxers and controls emerged for the presence of both depressive (p<0.01) and manic symptoms (p<0.01) in MOODS‐SR, and for stress sensitivity (p<0.01), anxious expectation (p<0.05), and reassurance sensitivity symptoms (p<0.05) in PAS‐SR. In particular, both mood (p<0.01) and panic‐agoraphobic (p<0.05) spectra symptoms seem to differentiate bruxers from controls in males, while in females strong differences emerged for stress sensitivity symptoms (p<0.05).

Conclusions: It can be confirmed that certain psychic traits are present in bruxers, while occlusal factors are not useful parameters to discern bruxers from non‐bruxers.
A baseline study of the demographics of the oral health workforce in rural and remote Western Australia
Authors: Kruger E. , Tennant M.
Published: March 2008

Background: A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce.

Methods: A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia.

Results: Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid‐thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums.

Conclusions: The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.