bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study of clinic attendance for pedodontic treatment of children with orofacial clefts
Authors: RANALLI DENNIS N. , ZULLO THOMAS G.
Published: March 2008

This paper analyzes attendance, cancellations, and disappointments of children with orofacial clefts who received pedodon‐tic treatment for 18 months compared with three other group— those receiving routine pedodontic services; those receiving interceptive orthodontic treatment; and physically or mentally handicapped patients receiving pedodontic treatment. Additionally, attendance of the patients with orofacial clefts for the 18‐month study is compared with a similar group for the previous 72 months.

The data were analyzed statistically by means of frequency distributions and x2 analysis. A total of 4,094 scheduled appointments were evaluated. The patients with orofacial clefts had the lowest frequency for attendance and the highest cancellation rate. x2 results indicate that this group had slightly fewer kept appointments and significantly more cancellations than expected. The comparison of attendance for 18 months with the previous 72 months for patients with orofacial clefts showed that the pattern of clinic attendance for the 18 months is representative for this sample group.
Pediatric dentistry and the child with asthma
Authors: MUNGO RICHARD P. , KOPEL HUGH M. , CHURCH JOSEPH A.
Published: March 2008

A child with asthma who needs dental treatment, can be a source of concern to the pediatric dentist. Recent studies have provided a better understanding of the pathophysiology of asthma as well as the role of emotions in the expression of asthma. The goal in managing the patient with asthma is to prevent an acute asthmatic episode during the dental procedure. Suggestions are made to meet this goal. Asthma does not require alteration of routine dental practices and, most importantly, the well‐managed child with asthma does not need special treatment when it comes to possible behavior problems in the dental office.
Von Willebrand's disease: indication for combined surgical procedures
Authors: RITCHIE JOHN R. , FLORINE BRENT L. , ANDES W. ABE , CUMINALE JOSEPH A.
Published: March 2008

The case presented illustrates several important aspects of von Willebrand's disease. Abnormal bleeding after dental extractions may be the first indication that a patient has a bleeding disorder. When replacement therapy is adequate, normal he‐most sis can be expected at the same time of surgery and after surgery. Multiple surgical procedures should be done where feasible. Orthopedic surgeons would probably hesitate to work simultaneously with dentists because of the perceived risk of joint infection secondary to bacteremia associated with dental procedures. However, many other procedures can be performed with success, as in the case reported here. Finally, until the time when virus‐free therapy (without the need of human donors) is available, the exposure of patients to blood components should be minimized by combining procedures and by using treatments such as Stimate whenever possible.
Behavioral and pharmacological dental management of a patient with autism
Authors: DAVILA JORGE M. , JENSEN OIVIND EKMAN
Published: March 2008

A 10‐year longitudinal report of case of an institutionalized autistic male dental patient is described. Interpretation of the data in the clinical and medical charts during this period points to possible clues to facilitating treatment for autistic individuals. One potentially important finding is the apparent inverse relationship that was found between level of sedation and patient cooperation. The impact of the specific medical diagnosis on the comprehensive care for these patients is also addressed.
Electrocardiographic examination of dental patients with systemic lupus erythematosus
Authors: Rhodus Nelson L. , Little James W. , Johnson Debra K.
Published: March 2008

Cardiac complications and abnormalities associated with systemic lupus erythematosus (SLE) have been well described. The most well‐recognized cardiac myopathies in SLE are pericarditis and valvular problems such as verrucous endocarditis. Electrocardiogram (EKG) abnormalities and arrhythmias have also occurred and such individuals may have persistent tachycardia. To determine the prevalence of dental patients with SLE who have these EKG changes, a pilot study was designed in which a group of 13 subjects with SLE underwent EKG monitoring in the clinic. Most of these were patients referred to the oral medicine clinic. A randomly selected group of age‐gender matched controls were monitored in an identical manner.

All subjects first completed a cardiac screening questionnaire, were comfortably seated, and then monitored. The results indicated that the overall prevalence of EKG abnormalities among the subjects with SLE was 61.5% (n=8). The most common arrhythmia was supra ventricular extra systoles. These were compared with a control group with a prevalence of 23% (n=3). Of the 76.9% of the subjects with SLE who reported a positive history of cardiac abnormalities, 80% demonstrated EKG abnormalities as compared with 50% of the control group. Of the subjects with SLE who did not report a previous history, none demonstrated EKG abnormalities as was the same for the control group. These results indicate a high prevalence of EKG abnormalities in dental patients with SLE, especially those with a positive cardiac history.
Defensive strategies for the institutional dentist
Authors: Burtner A. Paul
Published: March 2008

This paper was originally presented at the Third Annual National Conference on Special Care Issues in Dentistry, April 12–14,1991, at the American Dental Association Headquarters, Chicago.

The practice of dentistry in the institutional setting differs from the private practice of dentistry in several ways. These dissimilarities can cause the “institutional dentist” to be vulnerable to criticism by state dental boards, human rights advocacy groups, and regulatory agencies.

Effective strategies have been developed for reducing the professional vulnerability of the dentist who provides oral health care in the institutional environment. This paper presents several workable solutions to the problems faced by the institutional dentist.
The utilization of a multi‐layer prosthesis to treat recurrent antral carcinoma: a case report and review of the literature
Authors: Miller Pierre A. , Maxymiw Walter G. , McLean Michael , Thomason Cindy , Brown Dale H.
Published: March 2008

This paper reviews the use of an intracavitary mold in the radiotherapeutic management of recurrent sub‐orbital carcinoma of the maxillary sinus. An overview of the clinical features of antral carcinomas and the concept of brachytherapy in the management of these lesions is presented. Brachytherapy is usually reserved for relatively accessible lesions. Post‐surgical and radiation‐induced trismus can be a complicating factor, as in the case presented, where the inter‐incisal distance was less than three millimeters. To circumvent the problem, a multi‐layer antral plug was utilized as a carrier for the radioactive sources, and its construction is described.
Infective endocarditis in a patient with Hodgkin's lymphoma: A case report
Authors: Meehan Sean , Schmidt Mark C. , Mitchell Paul F.
Published: March 2008

A common sequela of certain malignancies is nonbacterial thrombotic endocarditis (NBTE), a phenomenon in which sterile fibrin/ platelet aggregates are deposited onto normal cardiac valves. These verrucae represent a predisposing factor for the initiation of infective endocarditis following a bacteremia. This paper presents a case history which is highly suggestive of infective endocarditis which occurred as a result of multiple odontogenic abscesses in a patient with Hodgkin's lymphoma. The case illustrates the important role that the dentist can play in the management of cancer patients and emphasizes a wholistic concept of medical care in which the dentist is an integral member of the health‐care team.
Pulpal obliteration related to long‐term glucocorticosteroid medication
Authors: Symons Anne L. , Symons David J.
Published: March 2008

Glucocorticosteroids (GCS) are used in the treatment of chronic autoimmune diseases and many long‐term illnesses. While these drugs may be considered essential for the patient's health, adverse reactions do occur. The incidence of adverse reactions depends upon the dose level and the duration of treatment. Three case reports of patients on long‐term GCS therapy are presented. Pulpal obliteration was assessed by radiographic records. In all instances, pulpal obliteration to some degree is described; however, the rate and extent of pulpal obliteration in the mature dentition seem greater than those occurring in the immature dentition. In the cases reported, the greatest dentin deposition appeared to occur on the roof of the pulp chamber, indicating that the pattern of dentin deposition by pulp tissue in GCS‐treated individuals is different from that of the normal aging process.
The Oral Hygiene Performance Test: Development and validation of dental dexterity scale for the elderly
Authors: Doherty S. Adele , Ross Angela , Bennett C. Ray
Published: March 2008

This paper describes a test which was developed for use in assessing the functional oral hygiene status of an elderly population. The instrument was tested among 80 community‐dwelling elderly subjects 65 or more years old. The instrument, the Oral Hygiene Performance Test [OHPT], is a direct‐observation measure which objectively quantifies the individual's ability to perform oral hygiene and thus reduces subjective evaluation. The test utilized several items from other already‐validated instruments currently in use in geriatric medicine to assess functional abilities in a geriatric population. Additional items were developed by the research team and were included in this 17‐item test.

The OHPT was validated with common measures of physical function and direct‐observation measures. Construct validity was assessed by comparison of the OHPT scores with other commonly used measures of other dimensions. The instrument proved to be reliable and demonstrated construct as well as concurrent validity. It appears that the OHPT can prove useful to clinicians in assessing the oral physical function of elderly patients with regard to their maintenance of oral hygiene. Because the OHPT is a direct‐observation instrument, it can even elicit higher functions in elderly patients. While effective among the studied population, the instrument may still need to be validated among more diverse populations, such as various ethnic groups and demented or severely impaired populations.
Incorporating the Nutrition Screening Initiative into the dental practice
Authors: Saunders Michèle J.
Published: March 2008

Older patients' nutritional status must be assessed for their morbidity and mortality to be decreased and their quality of life Improved. Food and fluid Intake is markedly Influenced by oral health status. In turn, oral health has an Interrelationship with general health. Because nutritional status and oral health exist in a symbiotic relationship, it is essential that the dental team Identify older patients who are nutritionally at risk. Screening for nutritional problems in elderly dental patients is made easier with screening Instruments developed by the Nutrition Screening Initiative (NSI). The NSI developed criteria to determine risk factors for poor nutritional status in older Americans. The DETERMINE Your Nutritional Health checklist, a 10‐Item screening Instrument, followed by the Levels I and II Nutrition Screens, can be used in the dental office to ascertain which elderly patients are most likely to be in danger of experiencing nutritional problems. The dental team can then perform Interventions and/or make appropriate referrals.
Tuberculosis risk in the hospital dental practice
Authors: Harlow Rand F. , Rutkauskas John S.
Published: March 2008

Tuberculosis has re‐emerged as a serious public health concern. Multidrug‐resistant strains and an increase in the number of high‐risk groups are posing a difficult problem for health care providers. The risk of TB transmission in hospital dental practices is potentially increasing. A 20‐question survey was mailed to the membership of the American Association of Hospital Dentists, addressing various issues relating to tuberculosis. One hundred thirty‐two surveys were analyzed. Twelve percent of respondents reported at least one TB skin test conversion by a dental provider within the past year at their institution. Five respondents reported one dental provider contracting TB through patient contact. Oral TB was reported in 21 cases.

Over 34% reported that active TB patients are not isolated to negative‐pressure isolation rooms, 45% reported that patients are allowed to frequent public areas, and only 59% believed that drug compliance monitoring was adequate. Over 86% support TB screening in the Hospital Dental Practice. It was concluded that Hospital Dental Practice personnel may be at increased risk for exposure to TB. Dental providers must exercise strict TB prevention and employ meticulous referral and follow‐up procedures for high‐risk patients.
A dental school's role in developing a rural, community‐based, dental care delivery system for individuals with developmental disabilities
Authors: Glassman Paul , Miller Christine Ernst , Lechowick Judy
Published: March 2008

The long‐standing problem of access to dental care for persons with developmental disabilities in rural Northern California has been addressed in several communities by a unique community‐based program. The goal was to create a coalition to coordinate dental school resources with those of a consortium of agencies to address problems in the local communities. This program established a community‐based model demonstrating the provision of quality preventive and therapeutic dental services to these individuals.

Through this program, dental care delivery systems were formed in three rural communities involving local community dentists and agency personnel. The role of the dental school was: (1) to establish and then work with a consortium of hospitals, agencies, dentists, and other dental personnel; (2) to train local dental personnel; (3) to establish and equip hospital dental facilities; (4) to conduct dental screening and triage clinics; (5) to consult with local agencies and dentists; (6) to act as a referral center for patients with complex medical situations; and (7) to develop and disseminate preventive dentistry training materials.
Hospital mouth‐cleaning aids may cause dental erosion
Authors: Meurman Jukka H. , Odont D. , Sorvari Rita , Odont D. , Pelttari Alpo , Rytömaa Inkari , Odont D. , Franssila Sami , Kroon Lars
Published: March 2008

Maintaining satisfactory oral health in bed‐ridden patients often calls for special aids, such as moistened cotton swabs. The purpose of thls In vitro study was to investigate three commercially available swab sticks meant for hospital use (DentiswabR, Lemon‐Glycerin SwabsticksR, and Lemon Glycerine SwabsR), and one saliva‐stimulant chewing tablet (CassisalR), regarding their possible erosive effects on dental enamel. A bovine enamel model system was used. Specimens were incubated for 4 hours In the test solutions made of the products.

The results showed statistically signlficant enamel softening caused by two of the cotton swabs (Lemon‐Glycerin SwabsticksR and Lemon Glycerine SwabsR). Incubation in the solutions made of DentiswabR cotton swabs and CassisalR tablets caused only minimal changes in microhard‐ness. Profilometric measurements supported these results.

Stereomicroscopy and SEM showed distinct erosion in specimens treated with the lemon swab solution, while the other two did not cause erosion. Thus, attention should be focused on choosing the less erosive products If special mouth‐cleaning aids are used.
Characteristics of patients with Autistic Disorder (AD) presenting for dental treatment: a survey and chart review
Authors: Klein Ulrich , Nowak Arthur J.
Published: March 2008

A group of 43 patients with AD (mean age, 13.5; SD, 5.9 yrs) was identified from the University Hospital School Pediatric Dentistry Clinic. We reviewed the patients' charts to obtain demographic data, dental findings, and the management techniques used for treatment. The patients were divided Into groups according to Frankl's categories of behavior, ranging from definitely negative to positive. Descriptive data are provided for each group. Commonly used communications and pharmacological management techniques, as well as physical restraints, enabled us to treat all the patients in the traditional dental setting, when simple procedures were planned. Treatment under general anesthesia in the operating room was necessary in 37% of all patients when comprehensive care was required or difficult procedures were carried out. A questionnaire was also sent out to the caregivers to gather data on patients' nutrition and eating/chewing habits. In the sample surveyed, two‐thirds of the individuals reportedly exhibited a normal eating pattern, while 14% pouched food. Soft, sweet, or sticky foods were preferred by 41% of the patients.
General anesthesia protocol for the dental patient: emphasis for older adults
Authors: Ghezzi Elisa M. , Chavez Elisa M. , Ship Jonathan A.
Published: March 2008

As the population ages, with increased retention of the natural dentition, there will be a greater responsibility for dental professionals to maintain the oral health of medically, behaviorally, cognitively, and physically impaired adults. Oral sedatives and nitrous oxide analgesia are frequently and successfully used for dental treatments in these patients. However, many compromised older adults cannot safely tolerate dental treatment with these sedative techniques in an outpatient setting. This paper describes the use of general anesthesia in a hospital environment, coordinated with medical and anesthesia specialists, that is a viable, safe, and effective treatment tool for providing comprehensive dental and oral surgical treatment for the older patient.
Effects of perceived patient attributes on dentist communication behavior
Authors: Thierer Todd E. , Handelman Stanley L. , Black Peter M.
Published: March 2008

The current study was designed to assess the relationship between dentists' communication behavior and their perception of patient attributes such as likeability, manageability, and prognosis. Six AEGD residents were videotaped, and their verbal and nonverbal communication behavior was analyzed in the manner described. Each resident was administered a 20‐item questionnaire to determine his/her perception of patient attributes. For overall dentist nonverbal behavior, perception of the patient and the amount of recognized interruptions that the dentist allowed were significantly correlated (r = 0.28, p < 0.05). When the three dentist perception subcategories‐Likeability, Manageability, and Prognosis‐were analyzed, verbal and nonverbal communication leads were significantly correlated with the dentists' perceptions of patient attributes in each. The hypothesis of a relationship between patient communication behavior and the dentists' perceptions of patient attributes was supported. The results suggest that dentists alter their communication behavior depending on their assessment of various patient qualities. Whether training in interviewing techniques and communication behavior would have an effect on this process is unknown and should be addressed.
Attitudes of the dental team to the provision of care for people with learning disabilities
Authors: Bedi Raman , Champion Jackie , Horn Rebecca
Published: March 2008

The aim of this study was to report on the evaluation of an attitude scale for General Dental Practitioners (GDPs) and Dental Auxiliaries/Professionals Complementary to Dentistry (PCDs), to determine the reliability of the scale with these two groups and to note any inter‐group differences. Seventy‐four GDPs and 89 PCDs completed the self‐administered questionnaires. The main outcome measures were reliability statistics, attitude scores, and factor analysis statistics. Reliability was satisfactory for both groups. PCDs scored consistently higher than GDPs on this attitude scale. Six factors were found to underlie the responses of GDPs, accounting for 62% of the variance. Seven factors were found to underlie the responses of PCDs, accounting for 65% of the variance. PCDs expressed more positive views about provision of care for patients with learning disabilities than did GDPs. Factor analysis revealed that GDPs were concerned about effectiveness of treatment and the stress related with treating patients with disabilities. PCDs appeared to be more concerned with the human rights of people with learning disabilities and how they fit into society.
Prevalence of dental caries in an adult population with mental disabilities in Spain
Authors: Vázquez Carmen Rodnguez , Garciflan Ma. Rosario , Rioboo Rafael , Bratos Eduardo
Published: March 2008

The objective of this study was to analyze the prevalence of dental caries and the possible influence of extraoral factors in a group of adults with a mild to moderate degree of developmental delay. A total of 166 subjects ranging in age from 20 to 40 years were examined. All subjects were institutionalized, and 70.4% (n = 117) participated in a preventive program designed by the educators of the center. This consisted of weekly fluoride mouthrinses (0.2%) and control of dental plaque by toothbrushing with a fluoride toothpaste. The mean DMFT index for the whole sample was 5.97. Subjects in the oldest age group had the highest DMFT index and the lowest filled component. There were no significant differences in the DMFT index and its components between the subjects who received a weekly fluoride mouthrinse (n = 117) and those who did not (n = 49). Comparison of subjects who had cerebral palsy, Down Syndrome, and idiopathic developmental delay (n = 157) found a significantly lower DMFT index (p < 0.05) in the persons with Down Syndrome compared with the other special‐needs groups. Other factors which could influence the results—such as fluoride use, oral hygiene, and administration of benzodiazepines—were also analyzed. An analysis of the results revealed a moderately high prevalence of caries in the whole sample that was lower than that in a national survey. This could be attributed to strict dietary control of sugar in the study population.
Severe gingival recession and early loss of teeth in a child with chronic graft versus host disease: a case report
Authors: da Fonseca Mareio A. , Murdoch‐Kinch Carol Anne
Published: March 2008

Graft versus host disease (GVHD) oceurs after a hematopoietic stem cell transplantation (HSCT) when the donors immune system rejects the recipienfs body, leading to significant morbidity and mortality. Increased numbers of chronic GVHD (c‐GVHD) patients are likely to be seen by dental professionals because of the advances made in transplantation. The oral cavity may be the primary or the only site of c‐GVHD and may have persistent lesions after resolution has oceurred in other areas.

Approximately 80% of patients with extensive c‐GVHD present some type of oral involvement, including xerostomia, oral pain and lesions. Dental and oral care can be challenging for these patients. This paper discusses the manifestations and treatment of oral c‐GVHD and presents the case history of a 15‐month‐old girl who developed severe oral GVHD with an unusual periodontal presentation and early loss of primary teeth.
Dentofacial features of a family with Crouzon syndrome. Case reports
Authors: Singer Steven L. , Walpole Ian , Brogan William F. , Goldblatt Jack
Published: March 2008

Crouzon syndrome is an autosomal dominant condition characterized by craniosynostosis with associated dentofacial anomalies. This paper describes the variable clinical features in affected individuals over two generations of a family with particular reference to the dentofacial deformities and discussion of management strategies.
Effect of preterm birth on oral growth and development
Authors: Seow W. Kim
Published: March 2008

Preterm and low birthweight children comprise approximately 6 per cent of all live births. They are prone to many serious medical problems during the neonatal period which may affect the development of oral tissues. The present paper reviews the results of this author's own decade of research into the oral development of preterm children in the light of current understanding of the field. Studies have shown a high prevalence of generalized enamel hypoplasia in the primary dentition of around 40–70 per cent in preterm children which is likely to be associated with low bone mineral stores. The clinical significance of enamel defects is poor aesthetics, and predisposition of the lesions to dental caries. Other dental defects observed in preterm children are localized enamel hypoplasia, crown dilacerations, and palatal distortions which are usually associated with traumatic laryngoscopy and prolonged endotracheal intubation. Furthermore, recent studies have demonstrated that the rate of dental development, and dental eruption may be affected by preterm birth. Children with the lowest birthweight and shortest gestational ages have the lowest rates of dental development, particularly before six years of age. The results of these clinical studies may have significant implications in the dental management of preterm children.
Supernumerary teeth: A review of the literature and four case reports
Authors: Scheiner Mark A. , Sampson Wayne J.
Published: March 2008

A review of the literature relating to supernumerary teeth is presented along with four case reports to illustrate some possible presentations, diagnostic features, and treatment options.
Musculoskeletal symptoms in New South Wales dentists
Authors: Marshall E. D. , Duncombe L. M. , Robinson R. Q. , Kilbreath S. L.
Published: March 2008

This study describes the prevalence and distribution of symptoms of musculoskeletal disorders occurring in New South Wales dentists and investigates the relationship between these symptoms and work practices.

Four hundred and forty two members of the Australian Dental Association (New South Wales Branch), were randomly selected and sent questionnaires. Eighty per cent (n=355) responded. No significant differences in reported symptoms were found when considering age, experience, handedness, operating position or period of working without a break.

Eighty‐two per cent of the respondents reported experiencing one or more musculoskeletal symptoms during the previous month. Sixty‐four per cent of the sample reported suffering pain (the majority reported back pain) and 58 per cent headaches. Most severe symptoms reported were pain (39%) and headaches (25%). Those in the youngest age category of less than 35 years (26%), were significantly more likely to have headaches (X24df p<0.05). Female dentists were more likely to rate the severity of their most severe symptom higher (X21df p<0.05), and to report more frequent pain (X22df p<0.05) and headaches (X22df p<0.05).

Those practising four‐handed dentistry were significantly more likely to be in the 35–44 age range (X24df p<0.01), to work for longer periods before taking a 10‐minute break (X25df p<0.05) and to report frequent pain (X22df p<0.05).

The results support the findings of previous studies conducted overseas but additional information about musculoskeletal symptoms in this occuptional group has been identified.
Arthroscopic management of temporomandibular closed lock
Authors: Miyamoto Hizuru , Sakashita Hideaki , Miyata Masaru , Goss Alastair N. , Okabe Koichi , Miyaji Yuuko , Sakuma Kuniko
Published: March 2008

Sixty‐three consecutive patients with painful closed lock involving 83 temporomandibular joints were treated by surgery and followed up for at lest 24 months. Prior to surgical treatment all had imaging to demonstrate that the cause of their painful jaw locking was an anterior displaced disc without reduction. All patients had received at least three months non‐surgical treatment without response. The arthroscopic surgery consisted of release of adhesions, manipulation and placement of 25 mg hyaluronic acid into the joint space. No significant surgical complications occurred. Postoperative treatment involved physical therapy and stabilization splints. At 24 months after surgery 57 patients (90.5 per cent) had no pain and mouth opening had improved from preoperative 27.2±5.4 mm to 44.4±4.1 mm (p<0.001). This study shows that arthroscopic surgery with continuing non‐surgical therapy is a highly effective treatment for painful closed lock.
The changing role of dental auxiliaries: A literature review
Authors: Baltutis Laura , Morgan Michael
Published: March 2008

A review of the literature on dental auxiliaries and their utilization in the dental workforce is presented, and their future role is examined in the light of broader issues relating to changing disease patterns and service delivery. Legislative factors, productivity, quality assurance and the potential scope for dental auxiliaries in both the public sector and private practice setting are discussed. A strategy for adopting a team approach in the delivery of dental services is suggested, which would necessitate the dentist taking on the role of team leader and maintaining responsibility for overall treatment planning and quality assurance. Dental auxiliaries could provide basic preventive and restorative dental services, allowing dentists to concentrate on providing more complex high‐technology treatment. Implications for the future training of dental auxiliaries are presented.
Oral cancer: Role of the basement membrane in invasion
Authors: Wilson David F. , De‐Jun Jiang , Pierce Angela M. , Wiebkin Ole W.
Published: March 2008

Invasive growth of cancer cell is a complex process involving specific interactions between tumour cells and the orderly, integrated complexes of the extracellular matrix. Basement membranes have been proposed as one constituent of extracellular matrix which carries responsibility for regulating invasion and metastasis. Using a chemically induced rat tongue carcinoma model, it has been shown that components of the basement membrane and its overall structure are altered during tumour invasion, and methods have been developed to quantitate some of these differences. Since the basement membrane can be specifically characterized by its fibrous protein network of Type IV collagen and laminin, which is embedded in a heparan sulphate‐rich proteoglycan matrix, these components have been targeted. In paticular, the current paper presents results in the context of current concepts of early changes in neoplastic invasion of underlying connective tissues. In consequence, further elaboration of the underlying mechanisms of epithelial migration in oral cancer may allow an exploration of the use of alterations in expression of basement membrane components as prognostic indicators.
Metastasis of thyroid carcinoma to the mandible: Case Report
Authors: Anil S. , Lal P. M. , Gill D. S. , Beena V. T.
Published: March 2008

Metastatic tumours to the jaw bones are uncommon. The incidence of jaw bone metastasis is difficult to assess accurately since the usual method to determine the distribution of a metastatic tumour has been by a radiographic skeletal survey in which the jaws are rarely included. At times, metastatic lesions of the orofacial region may be the first evidence of dissemination of a known tumour from its primary site. A case of metastatic follicular carcinoma of the thyroid to the mandible is presented. The present case emphasizes the importance of considering metastasis in the differential diagnosis of a radiolucent lesion in the mandible in a patient with a history of any malignant disease.
Studies of dental root surface caries. 1: Comparison of natural and artificial root caries lesions
Authors: McIntyre J. M. , Featherstone J. D. B. , Fu J.
Published: March 2008

Qualitative polarized light microscopy and cross‐sectional microhardness testing profiles were used to compare artificial root caries lesions with those naturally present in extracted human teeth. The artificial lesions were produced by immersion of roots with exposed windows in chemical buffers of acetate and lactate with no added enzymes or bacteria. The three buffer systems used produced lesions with the range of histological characteristics of natural lesions. These included a ‘body’ or ‘surface’ zone of the lesion when viewed in water, and a ‘frontal’ zone of reverse birefringence when viewed in quinoline. The ‘frontal’ zone was noted to first develop after three days of immersion in acetate buffer. Advanced natural lesions exhibited a wide, diffuse, advancing front, which was similar to that produced by 28–60 day lesions in acetate.

Microhardness profiles of natural lesions could all be matched by one or more of the artificial lesions. The demineralizing process was seen to reduce mineral content across the lesion from 45 per cent in normal dentine to between 15 and 25 per cent.
A comparison of Kodak Ultraspeed and Ektaspeed Plus dental X‐ray films for use in endodontics
Authors: Moule Alex J. , Wong Andrew , Monsour Paul A. , Basford Kaye E.
Published: March 2008

Background: The advantage of using a faster film for length determination in endodontic therapy is obvious. However, for such a film to be generally accepted, it must demonstrate comparable diagnostic quality to traditionally used films.

Methods: The comparative accuracy of canal length determination of Ultraspeed and Ektaspeed Plus dental X‐ray films was assessed in maxillary first and second molars; for different canals, for different teeth, for different exposures, and for different examiners (five general dentists and three endodontic specialists).

Results: In general, there were no significant differences between films, among examiners, or any interaction between films and exposures. That is, an assessor's ability to estimate lengths was not significantly influenced by the film type or by exposure used. There was a wide divergence in the individual assessor's ability to estimate lengths. Specialists estimated lengths more accurately than general practitioners and estimated lengths more accurately with Ektaspeed Plus film. Length determination in distobuccal and mesiobuccal canals was more accurate than in palatal canals. Most palatal canals were underestimated in length by more than 1mm. The use of file sizes larger in number than size 15 is recommended in these canals.

Conclusion: For length determination, Ektaspeed Plus dental X‐ray film is as effective as Ultraspeed film. Given the acceptable quality and accuracy of Ektaspeed Plus film, there seems to be no clinical reason to subject patients to greater radiation by using a slower film during endodontic therapy.
Displacement of a Mandibular Third Molar Root Fragment into the Pterygomandibular Space
Authors: Tumuluri V. , Punnia‐Moorthy A.
Published: March 2008

Displacement of root fragments into adjacent anatomical areas is an uncommon complication of the removal of teeth. This paper describes the management of a mandibular third molar root fragment that was forced into the antero‐inferior aspect of the pterygomandibular space. The importance of tomographical radiographs in the visualization of the displaced root is also discussed.
Caries, Bitewings, and Treatment Decisions
Authors: Tan PLB , Evans RW , Morgan MV
Published: March 2008

Background: The most common adjunct to the visual and tactile clinical examination for dental caries is the bitewing radiograph. The aim of this study was to report on treatment planning decisions made by Victorian dentists when given a range of predetermined radiographic scenarios.

Methods: A postal survey was conducted to obtain data from 550 dentists selected systematically (every fourth dentist) from the register of the Dental Board of Victoria (1996).

Results: The survey response rate was 64 per cent. Fifty per cent of responding dentists selected an operative intervention for radiographic lesions confined to enamel.

Conclusions: A review of current dental literature does not support this approach because a large proportion of proximal tooth surfaces that have associated radiolucencies confined to enamel are not cavitated. This study supports the need for continuing education programmes on the management of dental caries; such programmes should follow an evidence‐based model.
Paracetamol Versus Paracetamol‐Codeine in the Treatment of Post‐Operative Dental Pain: A Randomized, Double‐Blind, Prospective Trial
Authors: Macleod A Gordon , Ashford B. , Voltz M. , Williams B. , Cramond T. , Gorta L. , Simpson JM
Published: March 2008

Background: Codeine is frequently added to paracetamol to treat post‐operative dento‐alveolar pain; studies have shown effectiveness in relief of post‐operative pain at high doses but at the expense of central nervous and gastrointestinal side effects. There has been no trial to compare the efficacy and safety of paracetamol 1000mg with paracetamol 1000mg combined with codeine 30mg.

Method: A randomized, single centre, double‐blind prospective parallel group trial was performed to compare paracetamol 1000mg with paracetamol 1000mg with codeine 30mg for the relief of pain following surgical removal of impacted third molars, and analysed on an intention‐to‐treat (ITT) basis. Eighty‐two patients were assigned randomly to receive either drug for a maximum of three doses. Patients recorded their pain intensity one hour after surgery and hourly thereafter for 12 hours.

Results: The average increase in pain intensity over 12 hours was significantly less in patients receiving paracetamol plus codeine than in those receiving paracetamol alone (p=0.03) ‐1.81cm/h compared with 0.45cm/h ‐ a difference of 1.13cm/h (95 percent Cl: 0.18 to 2.08). Of the patients who received the paracetamol codeine combination, 62 per cent used escape medication compared with 75 per cent of those on paracetamol alone (p=0.20). There was no significant difference between the two groups in the proportion of patients experiencing adverse events (p=0.5).

Conclusion: A combination of 1000mg paracetamol and 30mg codeine was significantly more effective in controlling pain for 12 hours following third molar removal, with no significant difference of side effects during the 12 hour period studied.
A Study of Titanium Release into Body Organs Following the Insertion of Single Threaded Screw Implants into the Mandibles of Sheep
Authors: Frisken KW , Dandie GW , Lugowski S. , Jordan G.
Published: March 2008

Background: Titanium is generally considered a safe metal to use in implantation but some studies have suggested that particulate titanium may cause health problems either at the site overlying the implant or in distant organs, particularly after frictional wear of a medical prosthesis. It was the purpose of this investigation to study the levels of dissemination of titanium from threaded screw type implants following placement of single implants in sheep mandibles.

Method: Twelve sheep were implanted with a single 10times3.75mm self‐tapping implant for time intervals of one, four and eight to 12 weeks. Four unoperated sheep served as controls. Regional lymph nodes, lungs, spleens and livers were dissected, frozen and subsequently analysed by Graphite Furnace Atomic Absorption Spectroscopy.

Results: Results associated with successful implants showed no statistically significant different levels of titanium in any organ compared to controls, although some minor elevations in titanium levels within the lungs and regional lymph nodes were noted. Two implants failed to integrate and these showed higher levels of titanium in the lungs (2.2‐ 3.8 times the mean of the controls) and regional lymph nodes (7–9.4 times the levels in controls).

Conclusions: Debris from a single implant insertion is at such a low level that it is unlikely to pose a health problem. Even though the number of failed implants was low, multiple failed implants may result in considerably more titanium release which can track through the regional lymph nodes. Results suggest that sheep would be an excellent model for following biological changes associated with successful and failed implants and the effect this may have on titanium release.
An overview of drugs and ancillary equipment for the dentist's emergency kit
Authors: Chapman PJ
Published: March 2008

The concept of a basic (i.e., essential) medical emergency kit suitable for a general dental practitioner varies somewhat between different authorities. A practitioner's choice is also dependant on the proximity of medical aid and the nature of the dental practice. Over recent years the trend has been to restrict the items to a minimum, in the interest of both common sense and safety, for example, just oxygen, adrenaline 1:1000, an oral carbohydrate source, glyceryl trinitrate and aspirin as first options. Ancillary equipment should include an oxygen therapy facemask, a pocket mask and a set of oral (Guedel) airways. Two further medication options for consideration are an aerosol bronchodilator and, in certain circumstances, an injectable antihypoglycaemic agent. This paper provides a selective overview of the subject. An absolute necessity is for dentists to be competent in Basic Life Support skills, and to maintain a complete and current medical history for all patients.
Fund allocation within Australian dental care: an innovative approach to output based funding
Authors: Tennant M. , Carrello C. , Kruger E.
Published: March 2008

Background: Over the last 15 years in Australia the process of funding government health care has changed significantly. The development of dental funding models that transparently meet both the service delivery needs for data at the treatment level and policy makers' need for health condition data is critical to the continued integration of dentistry into the wider health system.

Methods: This paper presents a model of fund allocation that provides a communication construct that addresses the needs of both policy makers and service providers.

Results: In this model, dental treatments (dental item numbers) have been grouped into eight broad dental health conditions. Within each dental health condition, a weighted average price is determined using the Department of Veterans Affairs' (DVA) fee schedule as the benchmark, adjusted for the mix of care. The model also adjusts for the efficiency differences between sectors providing government funded dental care. In summary, the price to be applied to a dental health condition category is determined by the weighted average DVA price adjusted by the sector efficiency.

Conclusions: This model allows governments and dental service providers to develop funding agreements that both quantify and justify the treatment to be provided. Such a process facilitates the continued integration of dental care into the wider health system.
The influence of the leaf gauge and anterior jig on jaw muscle electromyography and condylar head displacement: a pilot study
Authors: Santosa RE , Azizi M. , Whittle T. , Wanigaratne K. , Klineberg IJ
Published: March 2008

Background: A leaf gauge and an anterior jig may be used to assist the recording of a reproducible jaw position for restorative and prosthodontic treatment. This study investigated possible condylar displacement using an opto‐electronic jaw‐tracking device and a leaf gauge or anterior jig. The effect of a leaf gauge and anterior jig on jaw muscle electromyography was also examined.

Methods: Five healthy adults without symptoms of temporomandibular disorders were selected. Condylar displacement during clenching were recorded simultaneously with electromyographic activity of superior and inferior heads of the lateral pterygoid, anterior and posterior temporalis, masseter, and suprahyoid muscles. Subjects were trained to bite at maximum and half‐maximum bite‐force using an anterior jig incorporating a force transducer.

Results: No consistent condylar displacement was observed in x, y and z axes between different bite‐forces although there was a trend towards superior displacement. Comparison of maximum intercuspal clench and maximum clench on a leaf gauge and an anterior jig produced significant decrease in anterior temporalis activity (p < 0.05), whilst an anterior jig with maximum clench significantly decreased posterior temporalis muscle activity.

Conclusion: Within the limits of this pilot study, no consistent change in condylar position was identified with these appliances.
Detectability of experimental peri‐implant cancellous bone lesions using conventional and direct digital radiography
Authors: Kavadella A. , Karayiannis A. , Nicopoulou‐Karayianni K.
Published: March 2008

Background
: The aim of this study was to compare the diagnostic performance obtained from direct digital radiographic images (in their original form and after applying a grey‐scale inversion) and conventional film in the detection of artificial periimplant cancellous bone lesions.

Methods
: Four titanium implants were placed into the cancellous bone of a dry mandible and increasingly larger bone defects were created in their approximal sites. Radiographs were taken using conventional film and a digital charge‐coupled device sensor. Twelve observers estimated three series of images (conventional, digital original, digital inverse) on a 5‐point confidence scale. Data were evaluated statistically by analysis of variance and the sensitivity, specificity and accuracy of the three imaging modalities were calculated.

Results
: Total mean observer confidence scores increased as the size of the defect also increased. No statistically significant differences were found among the three images for the absence of defect and the defect that corresponds to the smallest bur size. Significant differences were found for larger bur sizes between the conventional image and the two digital images and for the largest bur size between the digital inverse and the other two images. Specificity was high and sensitivity relatively low.

Conclusions
: Peri‐implant bone lesions must exceed a certain size to be confidently detected but the lesion absence is detected equally well with all three imaging modalities.
An unusual maxillary first molar with four roots and six canals: a case report
Authors: Adanir N.
Published: March 2008

This case report presents an unusual maxillary right first molar with four roots and six canals. Endodontic treatment was provided and final restoration was accomplished with composite resin. Treating extra canals in maxillary first molars may be challenging. Inability to find and properly treat the root canals may cause failures. Complete clinical and radiographic examination and a thorough knowledge of the morphology of these teeth is necessary for successful clinical results.