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PubMedDate not supplied

Using intravenous sedation to manage adults with neurological impairment.

Dental care for most medically compromised patients can be accomplished if dentists understand the patients' specific medical conditions and use standard conservative behavioral or physical modifications to prevent complications from occurring. However, in patients who have certain types of neurological conditions, specifically Alzheimer's disease and other types of dementia, dental management typically presents a greater challenge, because, in most kinds of dementia, patients are unable to follow directions or cooperate with simple instructions such as opening their mouths or holding their heads still. This report describes a three-year retrospective chart review of patients, diagnosed with a neurologic impairment, who underwent intravenous sedation at the Department of Veterans' Affairs Medical Center in Lexington, Kentucky. The goals of this review were to investigate the average doses of commonly used sedative agents, review complications as a result of the sedation, and comment on the safety of intravenous sedation as a means to treat elderly adults with a neurological disability.

Adult↗
PubMedDate not supplied

Assessment of objectives of post-doctoral general dentistry programs in Canada.

Objectives of hospital-based post-doctoral general dentistry programs in Canada were assessed by questionnaire. Seventy percent (14 of 20) of the program directors responded. Educational goals and objectives were assessed in professional skills and practice management, public health and preventive dentistry, oral medicine and pathology, special needs patient care, trauma and emergency care, restorative/prosthodontic care, endodontics, orthodontics/pediatric dentistry, oral surgery, periodontics, pharmacology, and functioning in a hospital. High rankings of proficiency were related to primary care, restorative/prosthodontic, endodontic, and surgical care. Emergency care, sedation, and pharmacology were also ranked highly. Lower rankings of proficiency were reported in orthodontics, aspects of public health dentistry, practice management, and advanced oral and maxiliofacial surgery. When the results of the Canadian survey were compared with those of a survey of US post-doctoral general dentistry programs, substantial similarity was seen. The findings support continuing reciprocity in accreditation standards between the Canadian and American Commissions on Dental Education and Dental Accreditation.

Anesthesia, Dental↗
PubMedDate not supplied

Periodontal health status and treatment needs among the elderly.

The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one > or = 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.

Aged↗
PubMedDate not supplied

Outreach dental service for persons with special needs in Hong Kong.

The authors describe the acceptance and efficiency of an outreach dental service, which provided oral health care to persons with special needs in Hong Kong. Portable dental equipment was transported to various institutions. Basic dental care including prevention, scaling, restoration, extraction, and denture repair was provided free of charge. Elderly adults living in institutions were the main service recipients, but other people with special needs, including physically disabled and persons with mental retardation were also reached. One-third of the patients had dental pain or sensitivity, and 70% had not visited a dentist for more than three years. Dental care was provided to 6,867 patients over four years. Feedback from the patients showed that more than 90% of them were satisfied with the service. These findings indicate that patients with special needs in Hong Kong are in great need of dental care. An outreach dental service appears to be both appropriate and efficient in providing care to these persons.

Adolescent↗
PubMedDate not supplied

Dental management prior to hematopoietic stem cell transplantation.

The authors investigated oral health treatment in patients scheduled for hematopoietic stem cell transplantation. Fifteen patients were scheduled for bone marrow transplantation: 12 had leukemia, two had aplastic anemia, and one had myelodysplastic syndrome. Twenty-three patients were scheduled to undergo peripheral blood stem cell transplantation: 20 had malignant lymphoma and three had leukemia. Patients with platelet counts of < or = 50,000/mm3 who required tooth extraction and those with platelet counts of < or = 30,000 /mm3 who required scaling received platelet transfusions before the dental treatment. We saw no bleeding problems in these patients. Dental care for patients who had neutrophil counts of > or = 500/mm3 included tooth extractions or scaling, with no postoperative infection. Even those with severe immunosuppression (neutrophil count: 100-150/mm3) tolerated treatment when prophylactic measures, such as intravenous administration of antibiotics, were used. One patient with a neutrophil count of < or = 50/mm3 developed an infection after even conservative therapy. Thus, caution should be exercised when treating patients scheduled for HSCT as even conservative therapy can initiate and infection.

Adult↗
PubMed1975

Comparison of impact strength of joints made with four dental cements.

Tests on 4 cements showed the impact strength of joints between gold and tooth structure varied somewhat with the surface roughness and cementing force. Polycarboxylate provided stronger joints although the results were variable. Little difference was found between zinc phosphate, zinc oxide-eugenol with polymethyl methacrylate, and zinc oxide-eugenol with ortho ethoxybenzoic acid.

Adhesiveness↗
PubMed1976

A simulated clinical appraisal of base materials for amalgam restorations.

Eight materials were placed as bases on the pulpal surface of cavities prepared in extracted teeth. Seven minutes after mixing of the material commenced, amalgam was condensed on to the lined cavity. The restored teeth were sectioned subsequently for microscopic examination. The results suggested that all uniformly mixed, carefully placed base forming materials that have reached the state of "clinical set" are able to withstand loads applied during amalgam condensation irrespective of their strength.

Calcium Hydroxide↗
PubMed1976

Overlay dentures. Philosophy and practice. II.

The practical stages in the construction of mandibular overlay dentures, with and without precision attachment anchors, are described and illustrated in detail. The importance of post-insertion maintenance, continuing effective oral hygiene and patient care, as a prerequisite for a successful overlay denture experience, is emphasized.

Dental Abutments↗
PubMed1977

An elementary study of deformation of molar teeth during amalgam restorative procedures.

A technique using an optical comparator was employed to examine the dimensional changes resulting from cavity preparation, application of the matrix and packing with amalgam in three extracted molar teeth. The changes have been reported and the nature of the change discussed. A modification in the use of the matrix and amalgam packing technique is suggested.

Dental Amalgam↗
PubMed1977

The influence of some manipulative factors on creep.

The effects of a number of factors on creep in dental amalgam was investigated. The factors studied were the delayed time between mixing and packing, the packing technique, the alloy system and the annealing or ageing of specimens at 37 degrees C for one and 190 days. The delayed time and the alloy system factors as well as an interaction between them had a significant influence on the one day annealed specimens. The alloy system in the 190 days annealed specimen was the only factor to affect creep.

Dental Amalgam↗
PubMed1982

Cuspal failures of MOD restored teeth.

It is observed clinically that some years after MOD restoration of molar and premolar teeth, cuspal failures commonly occur. The period between restoration and failure is usually from eight to fifteen years. Evidence has been found, both from observations of fractured cusps and from a mathematical model of an idealized molar tooth, that allows a clear description of the mechanism of these slow failures. Suggested changes in clinical practice are recommended if such failures are to be prevented in the future.

Dental Cavity Preparation↗
PubMed1990

Correlation between fracture properties and clinical performance of composite resins in Class IV cavities.

One hundred and two Class IV cavities were restored randomly with four composite resins. The restorations were assessed at six months, one year, two years and three years for surface chipping, bulk fracture and incisal wear. The data were correlated with various mechanical properties of the materials. A significant correlation was found between surface chipping/bulk fracture and fracture toughness (P = 0.002), elastic modulus (P = 0.006) and tensile strength (P = 0.045). There was a trend towards an association between incisal wear and both elastic modulus and inherent flaw size. Fracture toughness may be a useful indicator of the clinical performance of composites in Class IV cavities.

Color↗
PubMed1996

The effect of endodontic access cavity preparation and subsequent restorative procedures on molar crown retention.

Preparation of an endodontic access cavity through a full crown may affect its retention. This study was undertaken to investigate the effects on molar crown retention of endodontic access cavities and their subsequent restoration. Thirty human molars were mounted in resin, crown preparations were cut and their surface areas were determined. Vented metal copings were cemented with zinc phosphate and the forces required to displace each coping were measured using a tensile-testing machine. The copings were recemented, access cavities were cut and their surface areas determined prior to the displacement forces being re-measured. The copings were recemented, assigned to two groups, and the access cavities were restored--Group 1 with amalgam; Group 2 with glass ionomer (GIC). Displacement forces were re-measured and the copings were recemented. The occlusal margins of the access cavities were bevelled and restored again prior to displacement forces being remeasured. Mean displacement forces were - Group 1: Original (kg force), 37.86 +/- 3.97; After access cavity, 29.28 +/- 3.22; Amalgam, 50.21 +/- 4.71; Amalgam + bevel, 46.45 +/- 6.21. Group 2: Original, 42.77 +/- 4.49; After access cavity, 39.25 +/- 5.91; GIC, 48.11 +/- 3.55; GIC + bevel, 39.63 +/- 5.31. Statistical analyses with paired t tests showed that retentive values with access cavities were significantly lower than with intact crowns. Amalgam or GIC restorations increased retention beyond original values, significantly with amalgam. Bevelled occlusal margins decreased retention of crowns with restored access cavities but this was not significantly different from the original values. A significant relationship existed between total surface areas of the crown preparations, areas of the occlusal tables, and retentive values for crowns without access cavities. The access cavity area, as a proportion of the total area of the preparation, was related to the decrease in retention.

Cementation↗
PubMed1997

Factors influencing long-term restoration survival in three private dental practices in Adelaide.

Very little is known of dentist and patient factors which may influence the survival or longevity of dental restorative materials placed in private practices. The present retrospective study investigated during 1992 the effects of six factors on the long-term survivals of five types of restorations placed by 20 male dentists in 100 adult patients, at 3 selected Adelaide dental practices. There were no significant effects on restoration survival from change, of dentist, and generally only one or two types of restorations had their survivals influenced significantly either by dental practice location, or by patient age, frequency of patient attendance, experience of dentist, and whether or not the restorations were replacements during the study period. Restoration survival was not influenced significantly by whether, or not, any replacements were made by the dentist who placed the initial restorations. The median survival times for amalgams were 22.52 years, resin composites 16.72 years, castings 13.75 years, and crowns an estimated 26 years. For glass-ionomers, 75 per cent were still present at 11.25 years.

Adult↗
PubMed1998

Gap measurement and bond strength of five selected adhesive systems bonded to tooth structure.

The ability of a restorative material to bond and seal the interface with tooth structure is perhaps the most significant factor in determining resistance to marginal caries. Thus, the quality and durability of marginal seal and bond strength are major considerations in the selection of restorative materials. The purpose of this study was to compare the bond strength and marginal discrepancies of five adhesive systems: All-Bond 2, Clearfil Liner Bond, KB 200, ProBond and AELITE Bond. Twenty-five buccal and 25 lingual cavities were prepared in 25 caries-free extracted molar teeth, giving 10 cavities for each of the 5 adhesive systems. All teeth were restored with the resin composite Pertac Hybrid, or PRISMA Total Performance Hybrid with their appropriate adhesive systems. After restoration, the teeth were thermocycled, were stained with a 1.5% aqueous solution of a procion dye (reactive orange 14) and sectioned coronally with a saw microtome. Three sections of 200 microns thickness were prepared from each restoration which were then examined microscopically to measure marginal gap widths using a confocal tandem microscope. Shear bond strength measurements were carried out on the dentine bond using a universal testing machine. The All-Bond 2 adhesive system was found to have higher shear bond strength and to have the least gap width at the cementodentinal margin.

Adhesives↗
PubMed1998

The effect of the mismatch between the core diameter of self-threading dentine pins and the pinhole diameter.

This laboratory study incorporated the use of three different sized twist drills to prepare pinholes in extracted upper molar teeth. The diameter of each pinhole was measured. A pre-measured self-threading pin was then placed in each pinhole. The amount of strain created during pin placement (placement strain), the temperature rise during pin placement, the amount of strain remaining (residual strain) within the tooth structure after pin placement and the removal force (retention) were recorded for each pin. The results showed that, during the placement of a self-threading dentine pin, the difference between the pincore diameter and the pinhole diameter was an important parameter. This difference determined the amount of strain created during pin placement, the temperature rise during pin placement, the amount of strain remaining within the tooth structure after pin placement and the retention of the pin. The placement strain, temperature rise, residual strain and retention were all greater when the pin core diameter exceeded the pin hole diameter.

Dental Pins↗
PubMed2000

Restoring the vertical dimension of mandibular incisors with bonded ceramic restorations.

Mandibular incisors are difficult to restore with conventional anterior crowns due to their small axial diameters. Crown preparation risks pulp exposure and results in a thin core of dentine. An experiment was designed to determine if increasing the thickness of ceramic to restore incisal edges affects the load at the point of restoration failure. Forty-eight mandibular incisors were randomly divided into four groups. The incisal edges of the teeth in three groups were reduced so that the coronal height was 7.5 mm (Group A), 6.5 mm (Group B), and 5.5 mm (Group C). Group D was designated as the experimental control. A fifth group (Group E), independent of the random sample, was introduced to the study for discussion purposes and was characterized by each of the incisors having an intact incisal edge of enamel. Groups A, B and C were prepared in a standard fashion for ceramic veneer restorations that were constructed to restore the vertical height of each tooth to 8.5 mm. Prior to cementation, the preparation surfaces were analysed and the relative surface areas of enamel and dentine were calculated. The ceramic restorations were cemented using a resin luting agent. The teeth were then thermocycled prior to loading at 135 degrees C until failure. The mean fracture load was 305 N (SD 134 N) for Group A, 403 N (SD 101 N) for Group B, 515 N (SD 296 N) for Group C, 587 N (SD 187 N) for Group D and 395 N (SD 129 N) for Group E. As determined by analysis of variance followed by a Sheffè multiple comparison test there was a significant difference (p < or = 0.01) between Group A and Group D. There were no significant correlations of load at failure with the percentage of exposed dentine, enamel surface area, total preparation surface area, and the incisal surface area. The patterns of failure of the fractured specimens were also analysed. There were significantly (p < or = 0.05) greater fractures of the ceramic restorations when they were bonded with the minimum incisal thickness of ceramic.

Analysis of Variance↗