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Biomedical subjects

J B Epstein

Publications and source records attributed to J B Epstein.

At least 91 records · Page 5Linked to original sources
PubMed1996

Progress in HIV and AIDS care.

These recent meetings emphasized the considerable progress that has been made in HIV/AIDS. The prospect for non-progression of the disease, improved management of complications arising from the condition, and the potential for additional progress were the hallmarks of these meetings. The considerable developments that have occurred make it necessary for the dental profession to continue to play a role in the recognition, diagnosis, and management of oral conditions, and to keep abreast of the considerable developments in this field-and the implications that these developments have for patients presenting with complications related to other conditions, which may include bacterial, fungal or viral infections and malignant disease.

AIDS Vaccines↗
PubMed1996

Temporomandibular disorders, headaches, and neck pain following motor vehicle accidents and the effect of litigation: review of the literature.

A literature review concerning the relationships between motor vehicle accidents and temporomandibular disorders, whiplash, headache, neck pain, and litigation was undertaken. The review shows that many patients recover or resume work prior to settlement, but most unsuccessfully treated patients do not generally recover following the settlement of legal claims; the postinjury problems are not strictly psychologic. Litigating patients and nonlitigating patients are often not dramatically different in most important regards (including pain and return to work), with litigating patients deserving the same treatment as other patients with chronic pain. It was found that postinjury neck symptoms and headaches can be persistent. Employment appears to be a better predictor of long-term outcome than compensation and litigation. In addition, limited consensus is available concerning prognostic factors. Patients with postinjury temporomandibular disorders tend to respond less well to treatment than do noninjury patients with temporomandibular disorders, as do litigating compared to nonlitigating temporomandibular disorders patients, but a cause and effect relationship is not known. The incidence of temporomandibular disorders following motor vehicle accidents may not be as high as has been claimed in whiplash cases. More research is required in the area of temporomandibular disorders, motor vehicle accidents, and litigation.

Accidents, Traffic↗
PubMed1995

A preliminary investigation of an association between dental restorations and carcinoma of the tongue.

The potential association of dental restorations and tongue carcinoma was studied. We reviewed the available pretreatment dental records of 133 patients with carcinoma of the tongue seen at the British Columbia Cancer Agency between 1958 and 1992. 75 patients had teeth adjacent to the ipsilateral side of the cancer (involved side) and the contralateral (control) side of the tongue, resulting in 150 tongue/teeth pairings. Overall there was no significant association between the presence of dental fillings and tongue carcinoma, as the prevalence of bilateral dental restorations was high. Dental restorations were found in 6 patients on the involved side only. Only 1 patient developed a cancer adjacent to normal teeth with contralateral restorations. We feel that this observation merits more study. Meanwhile, careful assessment of dentition and aggressive treatment of dysplastic lesions are warranted.

Adult↗
PubMed1995

Exfoliative cytology and electron microscopy in the diagnosis of hairy leukoplakia.

The diagnosis of lesions clinically suggestive of hairy leukoplakia was assessed by light and electron microscopic examination of cytologic smears. We found exfoliative cytology to be a simple and noninvasive technique that can confirm the clinical diagnosis of hairy leukoplakia. Our results suggest that electron microscopy may be more sensitive and reliable than light microscopy in confirming the clinical diagnosis of hairy leukoplakia.

AIDS-Related Opportunistic Infections↗
PubMed1995

Assessing viral retention and elimination in rotary dental instruments.

The authors of this article used a laboratory model of herpes simplex virus infection to assess the potential for contamination of dental handpieces by a human viral pathogen. They found that although all the handpieces in the study were fitted with anti-retraction valves, it was not until the units were flushed internally and disinfected externally that the pathogens were eliminated.

Dental High-Speed Equipment↗
PubMed1995

A combined analysis of a toothbrush, foam brush, and a chlorhexidine-soaked foam brush in maintaining oral hygiene.

Oral hygiene in immunocompromised patients is important in preventing oral infection and may be important in preventing systemic infections. By mechanically reducing bacterial plaque levels in the oral cavity, the risk of infection may be reduced. Foam brushes have been shown to be ineffective in controlling plaque levels and gingivitis. In a 2-week trial, we demonstrated that using a foam brush soaked in chlorhexidine reduces plaque and controls gingivitis as effectively as using a toothbrush. Foam brushes soaked in chlorhexidine should be used when toothbrushing cannot be performed.

Analysis of Variance↗
PubMed1995

Dentistry and tuberculosis in the 1900s.

The number of new cases--or incidence--of tuberculosis is increasing in nearly every region of the world. A number of forces have resulted in the increased incidence of TB in developed countries, including the HIV epidemic, homelessness, and emigration from highly endemic regions. Although the number of new cases in Canada is relatively constant, the TB experience in the United States serves as a reminder that this situation could change rapidly. The appearance of multidrug-resistant tuberculosis has added to the urgency of situation. The basic methods of preventing TB transmission include preventing the release of the organism into the air, removing the organism from the air, and preventing the inhalation of the organism. Identifying and appropriately treating every person with active tuberculosis is an extremely important component of the control strategy; adequate ventilation, filtering air, and ultraviolet germicidal irradiation are methods used to remove the organism from the air; and masks and other personal protective devices, such as high-efficiency particulate air filters (HEPA), have been suggested as a means of preventing inhalation of the organism. In addition, identifying new TB infections and using chemoprophylaxis often prevents infection from progressing to active disease. Given the route by which tuberculosis is transmitted, it is necessary for both dentists and allied dental personnel to be aware of the risks they may face in day-to-day practice, and the means by which they can protect themselves and their patients.

Air Microbiology↗
PubMed1995

Survey to assess dental practitioner's knowledge of infectious disease.

The prerequisite to understanding the need for infection control practices in dentistry is a sound knowledge of infectious disease and the potential for its transmission in the dental setting. To assess the infectious disease knowledge-base of dental practitioners, a questionnaire was developed and distributed to dentists in British Columbia. The survey results showed that many of the mechanisms, routes and risks for the transmission of viral pathogens in the dental setting are not clearly understood by dentists. Continuing education is needed to ensure that compliance with current infection control recommendations, and the provision of appropriate patient care, continues to be based on a clear understanding by dentists of the mechanisms of infection. By identifying the current infectious disease knowledge-base of dentists, this survey may permit more specifically-directed continuing education programs to be offered.

Adult↗
PubMed1995

Compliance to recommended infection control procedures: changes over six years among British Columbia dentists.

Over the last decade, in response to the heightened awareness of HBV and HIV infections, world health authorities have produced specific infection control recommendations for dental practices. Surveys have been done in various countries to investigate the level of compliance to these recommendations. This paper reports on the changes in compliance over a six year period among British Columbia dentists, as indicated from four volunteer surveys conducted between 1987 and 1993. During that period, the percentage of dentists who reported taking a medical history for each new patient increased from 70 per cent to 99 per cent. The routine use of gloves increased from 61 per cent to 95 per cent, and of face masks from 49 per cent to 83 per cent. In 1993, most dentists (91 per cent) used a new pair of gloves with each patient, up from 62 per cent three years earlier. Dentists also reported on their sterilization and hygiene methods. Autoclavable handpieces were used by 66 per cent of respondents in 1990, and by 74 per cent in 1993. High-speed autoclavable handpieces were used by 83 per cent of dentists in 1993, but only 62 per cent sterilized these handpieces. Similarly, 65 per cent reported using low-speed autoclavable handpieces, but only 47 per cent sterilized them. It is apparent that disinfection of handpieces and intraoral instruments is still an important part of regular operatory hygiene. Biologic monitors were used by 61.6 per cent of respondents to test the efficiency of their office sterilizer in 1993.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Survey of knowledge of infectious disease and infection control practices of dental specialists.

A questionnaire was developed to assess the knowledge of clinical specialists regarding infectious disease as well as their infection control practices. The questionnaire was mailed to 202 dental specialists in British Columbia. Seventy per cent returned completed surveys. Their responses indicate that the mechanisms, route and risk of transmission of the viral pathogens of importance in dental practice are not clearly understood. However, infection control practices closely follow the guidelines set forth by the Canadian Dental Association and the licensing bodies, including immunization for hepatitis B (82 per cent), glove use (in 89 per cent of non-surgical and 95 per cent of surgical procedures), and sterilization/disinfection of dental handpieces (94 per cent). Compliance with infection control guidelines was similar to that reported in the United States, where strict enforcement has been instituted. The majority of dental specialists (84-88 per cent) were either treating or willing to provide treatment to patients with infectious disease. Continuing education in the area of infectious disease is needed to improve dentists' understanding of the risk of transmission to dental providers and patients. This will ensure that compliance with infection control recommendations and appropriate patient care practices continue.

Analysis of Variance↗
PubMed1994

The efficacy of sucralfate suspension in the prevention of oral mucositis due to radiation therapy.

PURPOSE: The purpose of this study was to assess the value of sucralfate suspension in prevention of oral mucositis and for reduction of oral pain in patients who develop mucositis during radiation therapy. METHODS AND MATERIALS: The study was a double-blind, placebo-controlled, randomized prospective trial of a sucralfate suspension in the prevention and management of oral mucositis during radiation therapy. Oral mucositis was assessed using a quantitative scale and symptoms were assessed using visual analogue scales. The statistical model was developed to detect a 40% reduction in mucositis. RESULTS: No statistically significant reduction in mucositis was seen. Early during radiation therapy less oral pain was reported in the sucralfate group, but as treatment progressed all patients experienced pain. Patients in the sucralfate group were prescribed topical and systemic analgesics later in the course of radiation therapy. CONCLUSION: Prophylactic oral rinsing with sucralfate did not prevent oral ulcerative mucositis. Sucralfate may reduce the experience of pain during radiation therapy.

Adult↗
PubMed1994

Topical application of capsaicin for treatment of oral neuropathic pain and trigeminal neuralgia.

Neuropathic pain may be a major cause of pain in the head and neck. Trigeminal neuralgia may appear as intraoral pain. This article reviews a series of 24 consecutive cases of oral pain treated with topical capsaicin. Complete remission of neuropathic pain was seen in 31.6% of patients; partial remission was achieved in 31.6% of patients. Trigeminal neuralgia with an intraoral trigger was less responsive to topical therapy than neuropathic pain. Further study is needed to clarify the efficacy of topical capsaicin in neuropathic and neuralgic pain and the effect of differing dosages and frequency of application. On the basis of the findings in this open-label clinical trial, controlled clinical study of capsaicin in neuropathic oral pain states appears warranted.

Administration, Topical↗
PubMed1994

A clinical trial of bethanechol in patients with xerostomia after radiation therapy. A pilot study.

The effects of bethanechol in the treatment of dry mouth were assessed in patients with xerostomia after radiation therapy to the head and neck. Bethanechol possesses muscarinic and nicotinic-cholinergic activity that likely accounts for its mode of action. Bethanechol (25 mg, three times daily) was not associated with significant side effects. Statistically significant increases in whole resting saliva (p = 0.003) and whole stimulated saliva (p = 0.001) were seen. In patients with pretreatment stimulated saliva volumes greater than resting saliva volumes, a positive response to subsequent use of the sialagogue was seen.

Bethanechol↗
PubMed1994

The role of malocclusion and orthodontics in temporomandibular disorders.

The recent literature is reviewed to assess the role of the dental occlusion in the etiopathogenesis of temporomandibular disorders (TMD) and the role of orthodontic therapy in preventing and treating TMD. Little evidence was found to support occlusal factors in TMD other than lack of posterior occlusal support and anterior open bite, which may represent predisposing factors in TMD. Orthodontic therapy may not affect the risk of developing TMD and has little role in treatment.

Humans↗
PubMed1994

Topical cyclosporin A for treatment of oral chronic graft-versus-host disease.

Graft-versus-host disease (GVHD) following bone marrow transplant is an important cause of morbidity and mortality. Oral involvement in chronic GVHD occurs frequently and occasionally is the manifestation of greatest concern to the patient. Management with systemic immunosuppression is the principal approach to therapy although topical application of corticosteroids may also be beneficial. We evaluated the use of cyclosporin administered as an oral rinse in patients with oral GVHD which remained active despite the prior use of systemic immunosuppression plus topical dexamethasone. Signs and symptoms of ulcerative oral GVHD improved > or = 50% in 7 of 11 patients (64%) treated with the addition of topical cyclosporin A. The topical use of cyclosporin A may represent a useful adjunctive approach in the management of oral GVHD.

Administration, Topical↗
PubMed1994

Hepatitis C: rapid progress in medicine and implications for dentistry.

Recent developments in the recognition and diagnosis of the major infectious cause of posttransfusion hepatitis, hepatitis C virus (HCV), have led to an explosion in research. These developments are of relevance to dental providers. Patients may now present to the dentist with a diagnosis of hepatitis C infection and may be undergoing medical treatment for this disease. The risk for transmission of HCV in the dental setting is minimal. The dentist must understand the implications for the diagnosis of HCV for the patient and for the provision of dental care.

Blood-Borne Pathogens↗