bluuebunny/crossref_metadata_2025 huggingface dataset:
An interdisciplinary approach to the management of complex medical and dental conditions
Authors: Rogers JPH , Stewart PR , Stapleton JV , Hribar DL , Adams P. , Gale AE
Published: March 2008

Dental and medical practice often requires an interdisciplinary approach integrating the knowledge, skills and experience of all the disciplines of dentistry, medicine and its associated fields into comprehensive treatment to maximize results. Rapid and comprehensive scientific and technological advances have made it difficult for dental and medical practitioners to keep up to date in their fields; thus, to decrease practitioner frustration and increase patient benefits, an interdisciplinary approach has become essential. This report illustrates how therapy was coordinated for a young medically compromised patient with dental phobia and significant dental problems. The latest advances in dental techniques and materials, medical technology and pharmacology are highlighted. The communication and cooperation of team members with each other and with the patient and guardians is illustrated. The astute observation by a medical practitioner in an unrelated discipline led to the improvement in the quality of life for a patient.
Quinine induced coagulopathy ‐ a near fatal experience
Authors: Hawthorne M. , Sim R. , Acton C.H.C.
Published: March 2008

A 67 year old man presented to his local dentist for restorative treatment. He stated he was fit and well and denied taking any medications. When he was given an inferior alveolar nerve block, excessive bleeding was noted at the injection site and the dentist advised the patient see an oral land maxillofacial surgeon. An appointment was made for the patient but he did not attend. Three days later, he presented with evidence of massive deep haemorrhage to the point of airway compromise. He underwent hospital admission, early intubation, intensive care for nine days and hospitalization for six weeks. The cause of his bleening was a severe thrombocytopoaenia, induced by chronic ingestion of quinine. He was self‐medicating with this to relieve muscular cramps. Despite this experience, the patient continued to deny that quinine was the cause of his problem and that he had failed in his obligations to advise the dentist of his drug history. Dentists need to be alert to the risk that patients may not reveal their true medical history. There are, however, obligations on the dentist to ensure the accuracy of information the patient gives and to ensure that patients whom they believe are at risk follow their advice. Teamwork and skilful airway management prevented this patient's demise.
Tooth loss and implant replacement
Authors: Henry P. J.
Published: March 2008

Osseointegrated dental implants are increasingly used to replace missing teeth in a variety of situations ranging from the missing single tooth to complete edentulism. The implant possibility must be carefully considered because treatment involves extended time frames, considerable expense and is not without risk. Accordingly, treatment‐planning decisions should have an evidence‐based strategy with appropriate risk assessment. Implant systems need to be adequately tested before they are released for general use and success rates should be assessed from peer review scientific publication data and not commercial promotional literature. It is the responsibility of the dentist to ensure the patient is educated so an informed decision can be made on difficult treatment alternatives. The clinical decision making process must respect the issues to assure quality of care and reduction of liability for negligent care. Today, the three‐unit fixed bridge can no longer be considered as the standard of care for restoration of a single missing tooth. The evidence has accumulated that the single tooth implant supported replacement is more conservative, more cost‐effective and more predictable with respect to longterm outcome in uncomplicated cases.
Analysis of fluoride levels retained intraorally or ingested following routine clinical applications of topical fluoride products
Authors: Heath K. , Singh V. , Logan R. , McIntyre J.
Published: March 2008

A variety of topical fluorides is now used clinically for the prevention and control of dental caries. It is essential for the dental profession to be fully aware of the relative retention rates of fluoride in saliva and thus its contact with the teeth. These may vary following the use of the different categories and concentrations of agents available and with different methods of use. It is also important to be aware of the amounts of fluoride ion ingested following use of the more concentrated forms and of the resultant elevation in total blood fluoride levels.

These parameters were investigated in a series of experiments invlolving human volunteer subjects using a variety of topical fluoride materials commercially available in Australia. Fluoride commercially available in Australia. Fluoride mouthrineses appeared to provide the highest salivary retention rates per dose of all forms of topical fluoride. Ingestion rates from concentrated gels were acceptable when effective evacuation methods were applied. The use of custom‐made trays resulted in a reduction in amounts of fluoride ion ingested, though simple self‐application by toothbrush of smaller quantities proved to be an effective alternative in terms of amount of fluoride ion retained in saliva per amount applied and ingested. None of the concentrated gels used resulted in elevations in total blood fluoride levels which were of concern in adults.

It is acknowledged that salivary retention rates of fluoride ion do not necessarily reflect the caries inhibitory effects of topical fluorides. However, these data provide some indication of possible advantages of some products and methods of application over others.
A protocol for the dental management of von Willebrand's disease, haemophilia A and haemophilia B
Authors: Stubbs M. , Lloyd J.
Published: March 2008

A guide for the dental management of the three inherited bleeding disorders, von Willebrand's disease, haemophilia A and haemophilia B, was established jointly by the Institute of Medical and Veterinary Science Transfusion and Haemostasis Unit in conjunction with the Medically Compromised Dental Unit at the Adelaide Dental Hospital. This protocol was subjected to a successful trial for 24 months.
A study of the dental treatment needs of children with disabilities in Melbourne, Australia
Authors: Desai Mala , Messer Louise Brearley , Calache Hanny
Published: March 2008

A selected population of children with disabilities in Melbourne, Australia, was studied with reference to their oral disease and treatment needs. A total of 300 children (aged 9–13 years), 150 attending special developmental schools (SDS) and 150 attending special schools (SS), received an oral examination and the parent/guardian completed a questionnaire. Six levels of function were defined, based on the child's independence for five selfcare activities (brushing teeth, feeding self, dressing self, walking and performing toilet). The caries experience of children in the SS was lower than in SDS (d+D: 1.3±1.6 versus 1.5±2.4; dmft+DMFT: 2.0±2.3 versus 2.5±3.1); those attending SDS had higher unmet preventive and restorative needs. Significant associations were seen between the number of decayed teeth, the dmft+DMFT index, and the level of function (p<0.005). Periodontal disease was prevalent; significant associations were seen between periodontal status, the need for periodontal therapy, and the level of function (p±0.005). Assessment of the level of function by staff could assist in triaging individuals for urgent dental examination. Despite 41 per cent of children requiring simple treatment, the preventive and treatment needs of many remained unmet. Following examination, diagnosis and treatment planning by a dentist, much of the preventive, simple treatment and oral health promotion could be performed by trained dental auxiliaries. An epidemiological survey followed by the implementation and evaluation of a long‐range public dental health care plan for children and adolescents with disabilities is needed urgently.
Concepts for the Prophylaxis of Infective Endocarditis in Dentistry
Authors: Tetsas Angelo , Ferguson Martin M.
Published: March 2008

Oral commensal microorganisms are commonly associated with the pathogenesis of infective endocarditis. Despite modern antimicrobial and surgical treatment, infective endocarditis continues to cause substantial morbidity and mortality. Although dentistry is no longer considered a major risk factor for infective endocarditis, it is current standard of practice that dental procedures likely to produce significant bacteraemia in patients who are susceptible to this disease be prophylactically covered with an antimicrobial agent. The concepts of antimicrobial prophylaxis prior to invasive dental procedures are outlined in this review, with particular reference to the latest recommendations of the Australian Dental Association.
The Oral Medicine of Tooth Wear
Authors: Young W G
Published: March 2008

This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro‐oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self‐management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.
Pits and Fissures: Etch Resistance in Prismless Enamel Walls
Authors: Burrow MF , Burrow JF , Makinson OF
Published: March 2008

Background: In a previous study to examine the nature of etching on the walls of fissures, there was a consistent result of resistance to deep etching on parts of the walls and a zone of lesser etching on part of the walls as evidenced by the uptake of stain. The staining had been used to examine the nature of the etch pattern. The aims of this study were to define the nature of this etch resistant area.

Methods: A sample of 55 teeth, both molars and premolars, were divided into three groups. In the first group the wetting of fissures by the etchant was examined; the second group tested for the effects of pellicle‐cuticle‐debris or air entrapment on the etching process. The final group looked at alternative mechanical treatments of the fissure prior to etching.

Results: The specimens split along the fissures showed clearly that the etch resistant zone was not due to lack of contact with the etchant or the presence of a pellicle‐cuticle‐debris covering, but to the presence of a prismless enamel structure. This study showed that this zone inhibited tag development on the fissure walls.

Conclusions: The mechanical removal of this prismless layer of enamel within the fissure system should result in an improved bonding of a fissure sealant through better tag development, in turn leading to a reduction in the failure rate of a sealant used to prevent caries.
The Shelf‐Life of Sodium Hypochlorite Irrigating Solutions
Authors: Clarkson RM , Moule AJ , Podlich HM
Published: March 2008

Background: Sodium hypochlorite (bleach) solutions are widely used as irrigants in endodontics. Their tendency to deteriorate is worsened by environmental influences which could cause loss of available chlorine content.

Methods: This study measured the loss of available chlorine concentration in a range of sodium hypochlorite solutions under conditions which mimic clinical usage and storage. Domestic bleach, both undiluted and diluted with demineralised water or hard water, was tested, along with Milton, for initial concentration of available chlorine, and then retested after varying periods and modes of storage to measure loss of chlorine concentration. The types of storage were: (1) in closed plastic bottles which were opened daily and agitated; (2) in open plastic bottles; (3) in syringes exposed to sunlight; (4) in syringes kept in the dark; (5) in open stainless steel bowls; (6) in closed stainless steel bowls; and (7) when heated to 50øC. Not all solutions were tested under all storage conditions.

Results: Of the solutions opened daily, undiluted domestic bleach was the most stable and Milton was the least stable. Initially, diluted bleach left open deteriorated rapidly but deterioration slowed with time. Solutions in syringes exposed to sunlight showed the most rapid loss of chlorine content. Heated bleach lost nearly 5 per cent of its strength in six hours. Diluted bleach surprisingly, increased its chlorine concentration in open bowls probably due to evaporation of water. Dilution of bleach with hard tap water did not significantly affect shelf‐life. Preloading of diluted bleach into syringes appears to be a sound technique if the syringes are stored away from light.

Conclusions: This study reinforces the need for sodium hypochlorite to be stored in closed opaque containers. Constant opening of containers appears to cause greater loss in chlorine concentration of diluted bleach solutions, perhaps because a lower concentration of sodium hydroxide allows the pH to drop more rapidly.
A Comparison of Stainless Steel Hand and Rotary Nickel‐Titanium Instrumentation Using a Silicone Impression Technique
Authors: Chen JL , Messer HH
Published: March 2008

Background: Root canal preparation using rotary nickel‐titanium instruments has been reported to be superior to hand instrumentation in terms of root canal shape, centring and frequency of procedural errors. The purpose of this study was to evaluate canal preparations using a sequential silicone impression technique to assess root canal morphology.

Methods: Pre‐operative canal impressions were obtained from 24 extracted single‐rooted premolars. Canals were randomly assigned to be firstly, instrumented with stainless steel K‐type files or rotary nickel‐titanium instruments (Profile), then further apically enlarged with rotary nickel‐titanium instruments (Profile or Lightspeed). Post instrumentation impressions were taken and digitally photographed in a bucco‐lingual and mesio‐distal orientation at low‐power magnification. Images were evaluated for procedural defects, changes in canal curvature, canal enlargement and canal rounding at 1, 3 and 7mm from the working length.

Results: Silicone impressions could accurately reproduce the detailed root canal morphology of single‐canal premolars. Repeated impressions of each canal using a standardized procedure allowed a detailed comparison of instrumentation techniques at various stages. Hand instrumentation incurred more errors than rotary nickel‐titanium instrumentation (Profile). Further apical enlargement using Lightspeed instruments incurred fewer errors than with Profile instruments. Differences among techniques were highly significant (p<0.005). All techniques resulted in slight canal straightening, as well as rounder and enlarged canals particularly in the apical third.

Conclusions: Rotary nickel‐titanium instrumentation, especially Lightspeed, may produce better canal shape by reducing procedural errors.
A Comparison of Kodak Ultraspeed and Ektaspeed Plus Dental X‐ray Films for the Detection of Dental Caries
Authors: Wong A. , Monsour PA , Moule AJ , Basford KE
Published: March 2008

Background: Using the fastest dental X‐ray film available is an easy way of reducing exposure to ionizing radiation. However, the diagnostic ability of fast films for the detection of proximal surface caries must be demonstrated before these films will become universally accepted.

Methods: Extracted premolar and molar teeth were arranged to simulate a bitewing examination and radiographed using Ultraspeed and Ektaspeed Plus dental X‐ray films. Three different exposure times were used for each film type. Six general dentists were used to determine the presence and depth of the decay in the proximal surfaces of the teeth radiographed. The actual extent of the decay in the teeth was determined by sectioning the teeth and examining them under a microscope.

Results: There was no significant difference between the two films for the mean correct diagnosis. However, there was a significant difference between the means for the three exposure times used for Ultraspeed film. The practitioners used were not consistent in their ability to make a correct diagnosis, or for the film for which they got the highest correct diagnosis.

Conclusions: Ektaspeed Plus dental X‐ray film is just as reliable as Ultraspeed dental X‐ray film for the detection of proximal surface decay. The effect of underexposure was significant for Ultraspeed, but not for Ektaspeed Plus. Patient exposure can be reduced significantly with no loss of diagnostic ability by changing from Ultraspeed X‐ray film to Ektaspeed Plus X‐ray film.
Tooth Wear in Children with Down Syndrome
Authors: Bell EJ , Kaidonis J. , Townsend GC
Published: March 2008

Background: Several studies have described the impact that dental caries and periodontitis may have on the dentitions of individuals with Down syndrome, but there are few reports about the effects of tooth wear. This investigation aimed to compare the aetiology, prevalence and severity of tooth wear in 49 cytogenetically confirmed Down syndrome children with 49 non‐Down syndrome controls.

Methods: This study involved three aspects: an oral examination, including obtaining dental impressions; a dietary analysis spanning three days; and a questionnaire seeking information about habits, medical problems and medications. Tooth wear severity was scored on a 4‐grade scale (none‐to‐little; moderate; severe; very severe), while aetiology was classified as being due to attrition mainly, erosion mainly, or a combination of both. Double determinations established scoring method reliability and chi‐square tests assessed associations between samples.

Results: Tooth wear was significantly more frequent (p<0.01) in the Down syndrome than the non‐Down syndrome sample (67.4 per cent cf 34.7 per cent), with more of the Down syndrome children showing severe to very severe wear (59.2 per cent cf 8.2 per cent). Significantly more Down syndrome children (p<0.05) displayed a multifactorial aetiology of tooth wear, i.e., both attrition and erosion (46.7 per cent cf 28.6 per cent), although no particular dietary link was established. Gastric reflux and vomiting were reported in over 20 per cent of the Down syndrome sample.

Conclusions: Given the potential consequences of high levels of tooth wear, associated with tooth grinding and an acidic oral environment in Down syndrome children, educational programmes aimed at increasing awareness of carers and health professionals are needed urgently.
Oral Health of Children with Gastro‐Esophageal Reflux Disease: A Controlled Study
Authors: Linnett V. , Seow WK , Connor F. , Shepherd R.
Published: March 2008

Background: The aim of this study was to compare the dental health of children with gastro‐esophageal reflux disease (GERD) with a healthy control group.

Methods: Dental examinations were conducted for 52 children (31 boys and 21 girls) with a definitive history of GERD. For every subject enrolled in the study, a healthy control sibling without the condition was recruited. Medical histories were obtained from medical records, and dental and dietary histories were obtained from parents. The teeth were examined for erosion, dental caries, and enamel hypoplasia, and sampled for Streptococcus mutans.

Results: The prevalence of erosion by teeth was found to be statistically significant between GERD patients (14 per cent) and controls (10 per cent) (p<0.05). GERD patients had erosion in more permanent teeth compared to controls (4 per cent vs 0.8 per cent, p<0.05), and more severe erosion (p<0.05). Caries experience was also higher in GERD patients compared to controls (p<0.05). Although there were more subjects with Streptococcus mutans in the GERD group compared to the control group (42 per cent vs 25 per cent), the difference was not statistically significant.

Conclusions: Children with GERD have more erosion and dental caries compared to healthy controls and should be targeted for increased preventive and restorative care.
Adhesions in the Temporomandibular Joint: Formation and Significance
Authors: Hase M.
Published: March 2008

Background: Adhesions are frequently seen in the deranged temporomandibular joint (TMJ). In the early stage of the degenerative process the adhesion does not seem to be a significant factor in reduced mandibular movement. This is reversed in advanced degenerative joint disease where the adhesion requires release to achieve a satisfactory clinical result. Correlation of clinical history and findings within the joint should increase understanding of limited jaw movement.

Methods: Arthroscopic examination of deranged TMJs was performed on 75 patients with limited jaw opening and correlated with the history of the derangement.

Results: A progressive maturation of adhesion formation was observed with longer standing symptoms. A different adhesion pattern was noted with derangement caused by direct trauma on the joint.

Conclusions: Internal derangement of the TMJ is associated with formation of intra‐articular adhesions. These are unlikely to be associated with reduced condyle movement in the early phase of the derangement. Later stage adhesions are more substantial and require release to achieve a satisfactory clinical outcome.
Ethical Dilemmas Confronting Dentists in Queensland, Australia
Authors: Porter SAT , Grey WL
Published: March 2008

Background: This paper details contemporary ethical dilemmas encountered by Queensland dentists.

Methods: An age‐stratified sample of 499 dentists resident in Queensland was surveyed. The questionnaire contained scenarios of five common ethical dilemmas. In addition, open‐ended questions sought the respondent's most frequent, difficult and recent ethical dilemmas, and where they would seek guidance in dealing with ethical problems.

Results: Respondents acknowledged the patient's rights in treatment decisions and the dentist's right to refuse demands for inappropriate treatment. However, responses varied in the extent to which dentists may influence treatment decisions. Few respondents would ignore evidence of poor dental treatment but they are evenly divided in choosing to inform the patient, the dentist or both. Poor quality treatment is the most frequent and difficult dilemma, and half have experienced this problem recently. Requests by patients for fraudulent receipts occur in a third of responses. Dentists develop ethical values from multiple sources but for help with dental ethical problems, 90 per cent of respondents would consult another dentist.

Conclusions: Of the ethical dilemmas discussed in this survey, those relating to poor quality treatment confronted most respondents. Also the actions of dentists in dealing with these dilemmas were most varied.
An Investigation into the Use of Pilocarpine as a Sialagogue in Patients With Radiation Induced Xerostomia
Authors: Frydrych AM , Davies GR , Slack‐Smith LM , Heywood J.
Published: March 2008

Background: Radiation therapy to the head and neck region can be an effective form of treatment for malignancies. Unfortunately damage to salivary glands may occur. Treatment of resultant dry mouth is at present very poor. The purpose of this pilot study was to investigate whether pilocarpine dissolved in artificial saliva and administered in a mouth spray would be effective in relieving such symptoms.

Methods: Twenty‐three patients with radiation induced hyposalivation were recruited for this randomized, double‐blind investigation. Subjects were randomly allocated to placebo or control medicaments used for eight weeks. All subjects were evaluated for the severity of their xerostomia associated symptoms prior to administration of the spray and again eight weeks later.

Results: The questionnaire and the visual analogue scale did not reveal any improvements in the dry mouth symptoms between cases and controls. Sideeffects were reported among cases, mostly mild and tolerable. All patients taking pilocarpine (with base salivary flow rates > Om1/min) demonstrated improvement in stimulated and unstimulated salivary flow rates. Candida counts decreased among the cases and controls although decrease among the cases was much greater.

Conclusions: The results obtained indicate that provided residual functioning salivary tissue exists, pilocarpine used as formulated is effective and warrants further investigation.
Pericoronal Radiolucencies and the Significance of Early Detection
Authors: Farah CS , Savage NW
Published: March 2008

Pericoronal radiolucencies are common radiographic findings encountered in general dental practice. They usually represent a normal or enlarged dental follicle that requires no intervention; alternatively they may represent a pathological entity that requires appropriate management and histopathological interpretation. A pericoronal space of greater than 2.5mm on an intraoral radiograph and greater than 3mm on a rotational panoramic radiograph should be regarded as suspicious. Although many pathological processes may present radiographically as pericoronal radiolucencies associated with unerupted teeth, the most common is the dentigerous cyst. These lesions may enlarge considerably if allowed to develop unchecked, and have the potential for pathological transformation. In this report we present four cases of large pericoronal radiolucencies associated with unerupted teeth, and highlight the importance of early detection and management of such lesions.
A Quick and Simple Method to Obtain a Radiographic Evaluation of Remaining Alveolar Bone Height Before Implant Placement
Authors: Blum IR , Smith GA
Published: March 2008

This article describes a method for making a diagnostic radiographic evaluation of remaining alveolar bone height in the bounded‐saddle patient without the previous fabrication of a study model and radiographic ball‐bearing template. The method presented is simple, enabling the busy practitioner to perform immediate radiographic diagnosis and inform the patient at the first visit about the available alveolar bone height at the site of planned implant insertion. This method is therefore time saving for both the dentist and the patient.
A study of the comparative efficacy of three common analgeisics in the control of pain after third molar surgery under local anaesthesia
Authors: Comfort MB , Tse ASK , Tsang ACC , McGrath C.
Published: March 2008

Background: The aim of this study was to evaluate the comparative efficacy of three commonly used analgesics (Panadeine, Diflunisal and Etodolac) in the control of pain after third molar surgery under local anaesthesia.

Methods: A randomized control study. Outcome of primary efficacy was judged by overall assessment of the area under the curve of graphs for pain intensity, measured from serial visual analogue scales over a 24‐hour period. Other measures of efficacy included the number (per cent) of patients who took ‘additional’ analgesics and the incidence of adverse effects occurring in each treatment group over the study period.

Results: The three drugs were effective in the control of post‐operative pain (p<0.01). Variations in pain intensity and the use of additional medication between the treatment groups were observed over the study period. The Diflunisal group experienced less pain than the Panadeine or Etodolac group (p<0.01). Furthermore, a lesser number of those in the Diflunisal group used additional medication compared to the other two groups (p<0.01). The incidence of side effects from all three drugs was low.

Conclusion: Diflunisal is superior in the control of pain following third molar surgery under local anaesthesia than either Panadeine or Etodolac, and has few side effects.
A survey of sodium hypochlorite use by general dental practitioners and endodontists in Australia
Authors: Clarkson RM , Podlich HM , Savage NW , Moule AJ
Published: March 2008

Background: Sodium hypochlorite is used commonly as an endodontic irrigant, but there are no published reports that provide details of its use. This survey sought to determine the percentage of Australian dentists who practiced endodontics, whether they used sodium hypochlorite for irrigation, and the manner of dilution, storage and dispensing sodium hypochlorite used by both dentists and endodontists.

Methods: All Australian endodontists and a stratified random sample of 200 general dentists in Australia were surveyed to address the issues identified above.

Results: Almost 98 per cent of dentists surveyed performed endodontic treatment. Among endodontists, nearly 94 per cent used sodium hypochlorite for irrigation compared with just under 75 per cent of general dentists. Sodium hypochlorite use by general dentists was more common in Victoria and South Australia than in other States. An infant sanitizer (Milton or Johnson's Antibacterial Solution) was used by just over 92 per cent of general practitioners and by more than 67 per cent of endodontists. All other respondents used domestic bleach. One hundred and sixty four of the respondents (80 per cent of endodontists and over 90 per cent of general dentists) used a 1 per cent w/v solution. Ten practitioners used a 4 per cent w/v solution, five used a 2 per cent w/v solution and four used a 1.5 per cent w/v solution. Eighty per cent of the practitioners who diluted their sodium hypochlorite before use, used demineralized water for this purpose. The remainder used tap water. Only four practitioners stored sodium hypochlorite in a manner which risked light exposure and loss of available chlorine content.

Conclusions: Sodium hypochlorite is commonly used as an endodontic irrigant and Australian dentists generally stored the material correctly.
Social and behavioural determinants of early childhood caries
Authors: Hallett KB , O'Rourke PK
Published: March 2008

Background: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region.

Methods: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self‐administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance.

Results: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income $20,000–$35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than $20,000 (OR=2.1, CI=1.5, 2.8).

Conclusions: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.
Intra‐alveolar distraction osteogenesis in preparation for dental implant placement combined with orthodontic/orthognathic surgical treatment: A case report
Authors: Baker B. , Gibbons S. , Woods M.
Published: March 2008

The use of implants has become a routine part of restorative dental treatment. The placement of implants requires a sufficient quantity of bone in which to place implant fixtures. Where such bone does not exist, a number of methods have been used to augment the affected area of the alveolar ridge. This case report describes the use of the relatively new distraction osteogenesis procedure to increase bone volume in a patient who required post‐traumatic restoration of several missing teeth, as well as comprehensive orthodontic and orthognathic surgical treatment.
Minor oral surgical procedures in patients on oral anticoagulants — a controlled study
Authors: Cannon PD , Dharmar VT
Published: March 2008

Background: Patients on therapeutic anticoagulation are at risk of bleeding from minor oral surgical sites. When the anticoagulant regime is modified to prevent the risk of bleeding, this at the same time predisposes the patient to risks of the medical condition for which they are being treated.

Methods: A total of 70 patients who were on warfarin treatment requiring minor oral surgical procedures were treated in the Oral Surgery Department. A control group of 35 had their warfarin stopped prior to the minor oral surgical procedure. The other 35 formed the study group. Patients with an International Normalized Ratio outside the therapeutic range of 2–4, or with history of liver disease or on drugs affecting liver function were excluded from the study. Any incidences of post‐operative bleeding were recorded.

Results: None of the patients in either control or study group had any serious bleeding complications.

Conclusion: The data suggest that patients can safely undergo routine minor oral surgical procedures without alterations of their therapeutic anticoagulation regime.
Acute leukaemia presenting as oral ulceration to a dental emergency service
Authors: Dean AK , Ferguson JW , Marvanr ES
Published: March 2008

Leukaemia is a neoplastic disease characterized by an excessive proliferation of immature white blood cells and their precursors. Oral lesions may be the presenting feature of acute leukaemias, which can be rapidly fatal if left untreated. This report describes the case of a 22‐year‐old female who presented to a dental emergency department with oral manifestations of acute leukaemia. It outlines the role of oral lesions in the diagnosis of acute leukaemias and emphasizes the importance of immediate referral by general dental practitioners.
Dental implants: Maintenance, care and treatment of peri‐implant infection
Authors: Chen S. , Darby I.
Published: March 2008

Osseointegration is becoming increasingly routine in the rehabilitation of partially or fully edentulous patients. However, the surrounding tissues may be subject to inflammatory conditions similar to periodontal disease and so require maintenance. This article discusses the background, aetiology, diagnosis of peri‐implant diseases, and the maintenance, care and treatment of peri‐implant infection in osseointegrated implants. Three case studies are presented to illustrate points in the care of implants.
Clinicians choices of restorative materials for children
Authors: Tran LA , Messer L Brearley
Published: March 2008

Background: Recently, there has been an expansion in the range of tooth‐coloured restorative materials available. In 1999, the National Health and Medical Research Council recommended clinicians use alternatives to amalgam in children ‘where appropriate’.

Methods: A three‐part 29‐item questionnaire was developed, tested in a focus group, and distributed to members of the Australasian Academy of Paediatric Dentistry (AA; paediatric dentists and paediatric dentistry postgraduate students; n=55), and the Australian and New Zealand Society of Paediatric Dentistry, Victorian Branch (SPD; general dentists and dental therapists; n=50). Participant information, material choices, and six hypothetical clinical scenarios were addressed.

Results: The overall response rate was 74 per cent. For both groups, the first ranked factor influencing choice of restorative material for vital primary teeth was child age, and caries experience for vital first permanent molars. For moderate‐sized Class I and II restorations in primary molars, a tooth‐coloured material was chosen by 92 and 84 per cent respondents respectively. For restoring two separate proximal lesions in a primary molar, 65 per cent chose a tooth‐coloured material followed by a stainless steel crown (27 per cent; all AA members), then amalgam (8 per cent). The SPD respondents were significantly more likely to choose glass ionomer cement for Class I and II restorations and for restoring two proximal lesions (all p=0.000) in primary molars than AA respondents, who were more likely to choose composite resins/compomers or amalgam/stainless steel crowns for these restorations. Younger respondents (21–40 years) were significantly more likely to choose composite resins/compomers or amalgam/stainless steel crowns (p=0.048) than older respondents (41–65 years), who were likely to choose glass ionomer cement.

Conclusions: For Class I and II restorations in primary molars, glass ionomer cement was the material chosen most frequently (SPD respondents); preference for amalgam or stainless steel crowns was low (both SPD and AA groups). The wide range of materials chosen for the hypothetical clinical scenarios suggests the need for guidelines on selection of restorative materials, and the need for longitudinal studies to follow actual clinical outcomes of the materials chosen.
A model for the prediction of tooth wear in individuals
Authors: Richards LC , Kaidonis JA , Townsend GC
Published: March 2008

Background: Easily applied, age‐specific standards are useful in assisting clinicians to decide whether the extent of tooth wear observed in a given patient at a specific age is acceptable or whether intervention is indicated.

Method: A simple method of scoring tooth wear and previously established mathematical relationships between tooth wear scores and age, provide the basis of a method for predicting tooth wear scores. In its most specific form, the method can be used to predict tooth wear scores for individual patients at subsequent ages. Alternatively, tables or graphs can be consulted to provide a less precise prediction of tooth wear that can assist clinicians to decide whether the amount of wear reflects high, moderate or low rates of wear at the specified age.

Conclusion: In cases where there is no reason to believe that aetiological factors have changed significantly over time, data obtained from the methods described can assist clinicians to plan appropriate management for patients presenting with unacceptable levels of tooth wear.
Minor salivary gland carcinoma involving the oral cavity or oropharynx
Authors: Hyam DM , Veness MJ , Morgan GJ
Published: March 2008

Background: Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection.

Methods: Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980–2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner.

Results: A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22–86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low‐grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow‐up 83 per cent of patients were alive and disease free.

Conclusions: Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.
Bond strength of simplified‐step adhesives to enamel prepared with two different diamond burs
Authors: Sevgican F. , Inoue S. , Koase K. , Kawamoto C. , Ikeda T. , Sano H.
Published: March 2008

Background: Self‐etching primers are reported to produce considerable etching on flat enamel surfaces. However, little is known about the influence of different enamel surface textures. In this study the influence of grinding enamel on bond strength of two all‐in‐one and one two‐step adhesives was investigated.

Methods: Resin composite was bonded to the ground enamel of extracted human third molars that was reduced 0.5mm from the buccal or lingual surfaces using either regular‐ or superfine‐grit diamond burs with each of the three adhesives. After 24 hours in 37°C water, the specimens were sectioned into slabs of 0.7mm thickness, trimmed to an hourglass configuration, and subjected to micro‐ tensile bond strength (MTBS) testing.

Results: For all adhesive systems, MTBS to enamel ground with a regular‐grit diamond bur was not significantly different from that with a superfine‐grit diamond bur. The etching patterns of these adhesives were partly varied according to the aggressiveness of the adhesives.

Conclusion: The use of two different burs does not affect the tensile bond strength of the adhesives to enamel.
Dens evaginatus and dens invaginatus in a maxillary lateral incisor: Report of a rare occurrence and review of literature
Authors: Mupparapu M. , Singer SR , Goodchild JH
Published: March 2008

A case of dens evaginatus (DE) and dens invaginatus (DI) concurrently affecting the maxillary right permanent lateral incisor in a 25‐year‐old Hispanic male is reported. DE, referred to as Talon's cusp in the anterior teeth and Leong's premolar in the pre‐ molar teeth, is a relatively rare condition by itself. An association of DI with this rare anomaly within the same tooth has never been reported before although it has been known to occur within the same patient. Since it is known that DE may be composed of normal enamel and dentine, as well as varying amounts of pulpal tissue, care should be exercised while performing any aesthetic procedures to remove or recontour it.
Tooth follicle extirpation and uvulectomy
Authors: Johnston NL , Riordan PJ
Published: March 2008

Migration is not only the movement of people, but also of their culture, customs and beliefs. As more people from developing countries in Africa migrate to industrialized countries, the more likely health professionals will find themselves providing care for people of whose customs and practices they have little knowledge. This review of the literature suggests that removal of deciduous canine follicles and uvulectomy are frequently practised in some African and neighbouring countries. Reasons given for deciduous canine extirpation include the prevention of vomiting, fever and diarrhoea. The indications for uvulectomy appear widespread, including treatment for persistent fever, coughing and growth retardation. The practices are usually performed by traditional healers. Risks for children who undergo these procedures are extensive, including septicaemia, potential for HIV transmission, numerous dental complications and death. With improved understanding between Western health teams and local, traditional people, an improved system may develop whereby the two systems can work together in providing improved health outcomes for the people.
The dental implications of bisphosphonates and bone disease
Authors: Cheng A. , Mavrokokki A. , Carter G. , Stein B. , Fazzalari NL , Wilson DF , Goss A N
Published: March 2008

In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non‐healing extraction wounds of the jaws. All were middle‐aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non‐healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates, pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non‐osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients.
Guided self diagnosis: an innovative approach to triage for emergency dental care
Authors: Smith K. , Clark A. , Dyson K. , Kruger E. , Lejmanoski L. , Russell A. , Tennant M.
Published: March 2008

Background: The basic model of triage, developed more than 200 years ago by the French, is based on categorization of patient needs and thus the urgency and time required for care. This model in various forms is used in most hospitals throughout the world.

Methods: In this study, a fully computerized guided self‐diagnosis system (based on a neural network design) was designed, prototyped, developed and trialled by front line non‐clinically trained personnel in emergency dentistry.

Results: A total of 699 patients were seen as a result of the triage assessment within 14 days of their initial phone call and/or first contact. Patients categorized as requiring care on the day (Category 1) were provided more items of care (50 per cent of all items) and the greatest number of extractions (76 per cent) and endodontic treatments (78 per cent). Other categories were found to require less urgent care.

Conclusions: The triage system developed in this study clearly holds significant promise in reducing the impact of emergency dental patients on dental health care systems. However, it is recognized that the system still requires some adjustment to ensure all Category 1 patients are examined before less urgent categories.