The three kinds of dental schools.
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Biomedical subjects
Publications and source records attributed to M H Anderson.
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Implantation of internal cardioverter defibrillators (ICDs) for treatment of malignant ventricular arrhythmias is complicated by failure of therapy or inappropriate shocks. We studied 81 patients (age range 16-72 years; mean 48 +/- 13 years) who underwent ICD implantation for device therapy. The underlying aetiology was ischaemic heart disease (39%), cardiomyopathies (32%) and others (28%). Information regarding shocks was collected using Holter monitoring, telemetry or device memory (stored electrograms) and lastly by clinical follow-up. Fifty-eight patients completed 36 months of follow-up. Thirty-five patients experienced 337 spontaneous shocks, appropriate in 21, inappropriate in 12, and both in two patients. Of the 74 episodes of inappropriate discharges for rhythms other that ventricular tachycardia (VT) or ventricular fibrillation(VF), 55 percent were due to supraventricular arrhythmias (atrial flutter or fibrillation). Lead malfunction occurred in four and the device was replaced in two. Additional drugs controlled AF in one. There was no mortality in any of the 81 patients. The frequency of shocks was highest in the first six months after implantation and atrial fibrillation remains the main cause. In conclusion, inappropriate shocks are frequent in patients undergoing ICD implantation.
The effectiveness of electronic dental anesthesia (EDA) for pain control during restorative procedures was compared with local anesthetic injection (LA) in 32 children aged 6 to 12 years. Each child selected had two antimere primary or permanent molars requiring similar-sized Class I or Class II restorations. The pain levels during restorative treatment were assessed using a visual analogue scale. Heart rates and behavior were also recorded. A crossover design was used with each child acting as his/her own control. The results showed that overall, EDA was less effective than LA for cavity preparation. The reported pain scores for EDA were higher in permanent teeth for the deeper cavities, and with one of the operators. The pre- or post-treatment anxiety scores were not found to differ significantly between the two restorative appointments. However, children with the highest pretreatment scores were more likely to report higher pain scores with EDA. Despite this, 63% of the children preferred EDA to LA. Dental anxiety, cavity depth, the tooth being treated, and operator attitude may also be important factors in determining the success of EDA.