Job-hopping and factitious victimization.
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Attitude of Health Personnel↗
Biomedical subjects
James C Hamilton
Publications and source records attributed to James C Hamilton.
Treatment decisions and conservation of tooth structure.
New technology is becoming available to help establish an early diagnosis of incipient and hidden pit and fissure caries, and microdentistry techniques are being developed to follow the principles of minimal intervention. Following the accurate diagnosis of suspected lesions, early intervention can be in the form of chemotherapeutics to promote remineralization or conservative intervention to minimize tooth structure loss. Patient risk factors should have a role in developing and individualized treatment program. The life cycle of a restored molar is used in this article to illustrate the long-term value of early diagnosis, preventive therapy, and conservative intervention to preserve tooth structure and to extend the retention of healthy teeth.
Decision Making↗
Should a dental explorer be used to probe suspected carious lesions? Yes--an explorer is a time-tested tool for caries detection.
The caries rate is dropping worldwide, a fact that appears to have no relationship to whether dentists in the affected countries use an explorer to probe suspected carious lesions. Questions have been raised about this procedure on the basis of the purported inaccuracy of its contribution to caries diagnosis, its possible spread of infective plaque from other teeth in the mouth or the damage it can cause to pits and fissures. Longterm randomized clinical trials are necessary in these areas of question, trials that use endpoints that are clear and meaningful to clinical dentists. Until the time comes that facts emerge from acceptable long-term clinical trials, dentists should feel comfortable using the dental explorer to probe suspected carious lesions.
Dental Caries↗
Early treatment of incipient carious lesions: a two-year clinical evaluation.
BACKGROUND: The purpose of this study was to quantify conservation of tooth structure and evaluate the efficacy of early treatment of questionable carious lesions in pits and fissures of posterior teeth using air abrasion followed by placement of preventive resin restorations. METHODS: Ninety-three patients with 223 questionably carious teeth, mainly with darkly stained pits and fissures, were recruited from general dentistry clinics. After baseline evaluation, each tooth was randomly assigned to either an early treatment or control group. The authors used air abrasion to investigate the pits and fissures of teeth in the early treatment group. The teeth were sealed and restored with a flowable resin-based composite. All teeth in both groups were examined at six-month intervals to clinically evaluate the quality of the restorations and the caries status of the control teeth. RESULTS: After two years, two of the 113 restorations in the early treatment group required further treatment because of penetrating stain at a margin. In the control group, 14 teeth required treatment because of caries. The mean weight of the impression material--a surrogate measure of volume of removed tooth structure--in preparations that extended into dentin in the early treatment group was 0.0260 grams compared with 0.0281 g in the control group. There was no statistically significant difference between the impression weights (P = .390). CONCLUSION: After two years of a proposed five-year study, the authors concluded that conservation of tooth structure was not substantiated by early treatment. CLINICAL IMPLICATIONS: Treating questionable carious lesions early may not conserve tooth structure.
Composite Resins↗
The Utian Quality of Life (UQOL) Scale: development and validation of an instrument to quantify quality of life through and beyond menopause.
OBJECTIVE: Quality of life (QOL) is an outcome variable requiring measurement in clinical care or pivotal regulatory trial research. Current menopause QOL measures are mostly life phase or disease symptom inventories or scores. Believing that QOL should refer more to "sense of well-being," we have developed the Utian QOL scale (UQOL) that is strongly based on perception of sense of well-being as distinct from menopausal symptoms. DESIGN: A pool of items sampling various aspects of well-being was developed. Peri- and postmenopausal women (n = 327) responded to the items, and their responses were subjected to a factor analysis. Four factors emerged, each representing a QOL domain. The resulting 23-item instrument was validated in a geographically and socioeconomically diverse sample of peri- and postmenopausal women using the Short Form-36, an established, frequently used QOL inventory. QOL domains were subjected to confirmatory factor analyses, formal item analysis was completed, and the measure was assessed for reliability and validity, including a second sample of women (n = 270). RESULTS: Women (n = 597; mean age, 52.9 years) from 12 communities across the United States completed the measure. The UQOL seems to reflect four components of QOL: occupational QOL, health QOL, emotional QOL, and sexual QOL. The questionnaire and scoring system are presented. CONCLUSION: We are reporting on the process of validating an instrument for quantifying sense of well-being in a perimenopausal population. Substantial reliability and validity estimates for the scale and its subscales support the UQOL as a valuable new tool for use in clinical research and practice.
Aged↗
DIAGNOdent measurements and correlation with the depth and volume of minimally invasive cavity preparations.
In this clinical study, DIAGNOdent (KaVo) was used to assess previously diagnosed carious lesions in the pits and fissures of first and second molars. The measurements from this device were correlated with the depth and volume of the cavity preparations that resulted from minimal intervention to remove occlusal carious lesions. Twenty-five patients, 18 years of age and older, who were previously scheduled for an occlusal restoration due to caries, were recruited and enrolled in this clinical study. These patients had 48 qualifying teeth without previous restorations, sealants or other carious lesions. The occlusal surface of each study tooth was cleaned utilizing ProphyFlex2 (KaVo). Two dentists separately traced the pit and fissure system of each tooth using DIAGNOdent for two 15-second periods each. The peak reading of each of the four measurements was recorded. An impression of the occlusal surface of each tooth was recorded with a polyvinyl siloxane bite registration material. The carious lesions were removed with an air abrasion unit employing a 0.015-inch nozzle opening utilizing minimal operative intervention. A low viscosity polyvinyl siloxane was used to take an impression of the cavity preparation impression, using the bite registration impression to form the occlusal surface of the preparation impression. The preparation impression volume was calculated from its weight, using the known density of the impression material. The greatest depth of the preparation was measured. The Pearson correlation coefficient was used to investigate any relationship between depth or volume of the preparation impression and the DIAGNOdent measurements. The correlation for preparation volume and maximum DIAGNOdent measurement was 0.191 (p = 0.189). Other logical subsets of cases also did not result in any statistically significant correlations between the DIAGNOdent readings and the depth or volume of the final cavity preparations.
Adolescent↗