The adult dental patient today, as a discerning consumer, is seeking the highest quality care in the realm of esthetic dentistry, and frequently these expectations can be met through the modalities of bonded composites, porcelain laminates, porcelain bonded to etched metal support structures or modified conventional crown and bridge prosthodontics. However, there are occasions where the individual tooth, teeth, or the arches are so aligned that the pulpal, gingival, or osseous tissues would be jeopardized by the conventional restorative intercession. The incorporation of accepted and routine procedures of acid etching and direct bonding of orthodontic appliances to the surfaces of the adult dentition to reposition malposed teeth offers the clinician a magnificent alternative or adjunct to the conventional dental material forms of treatment. This article will present several patient treatments that incorporated the use of acid etching and direct bonding of orthodontic appliances to the surfaces of the patient's teeth for the purposes of repositioning the teeth with or without the need for restorative interventions.

Acid Etching, Dental↗

PubMedDate not supplied

Reverse Maryland bridges: clinical applications.

The "Maryland Bridge" or the etched metal-composite bonded retainer has experienced a variety of clinical applications since its inception as the etched enamel plastic-bonded Rochette periodontal splint. Through the evolutionary stages of different metals and framework preparation for composite bonding by electrolytic, chemical, and air-abrasive procedures and the improvements in bonding composites, the bridge has been in clinical use for approximately 9 to 10 years. Certain clinical and radiographic criteria must be satisfied prior to using the conventional Maryland bridge, but with the unique application of the basic bridge design modified and placed from the labial or buccal position some previously contraindicated uses of the bridge can be reversed by using a unique, if not provocative, application of the bridge design principles. This article presents two clinical case reports utilizing the Maryland bridge applied from the labial and buccal aspect. Both fixed partial dentures presented have been in place clinically for over 18 months, whereas others of this type have been successfully in place for over 6 years.

Acid Etching, Dental↗

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Emergency dentures and esthetics.

Accidents occur in life and when they affect the dentition, whether natural, artificial, or a combination, they can result in a feeling of dread and despair in the patient. The thought of appearing not only in public with business and social acquaintances, but also in private with family members can be reprehensible. This article discusses the use of visible light-cured denture base materials that can be used to alleviate the fear these patients display in being exposed to socio-esthetic intercourse when becoming suddenly partially edentate. The method of use and three patients' photographic essay presentations are discussed.

Acrylic Resins↗

PubMedDate not supplied

Disclosing doctors' incentives: will consumers understand and value the information?

As part of a broader movement toward accountability in health care, federal and state governments have required health plans to disclose physicians' financial incentives. Available data suggest that patients have poor comprehension of the incentives and significant barriers to learning, including high trust in their physicians, reluctance to think of the physician/patient relationship in financial terms, and failure to understand the relevance of the information to their health care choices and treatment. Disclosure that conveys clearly what is at stake will increase the salience of incentive information but is also more likely to erode trust.

Attitude to Health↗

PubMedDate not supplied

Adult orthodontics as an adjunct to restorative care.

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Touch contamination of connection devices in peritoneal dialysis--a quantitative microbiologic analysis.

OBJECTIVE: To determine the level of bacterial contamination associated with touch contact of a connector set during peritoneal dialysis (PD). DESIGN: The experiment utilized a laboratory-based simulation of a bag exchange procedure. Deliberate touch contamination of the connector set spike was followed by quantitative recovery of micro-organisms from the connector and, in some cases, the dialysis bag. SUBJECTS: Patients undergoing PD were used as the "test" group. Departmental secretarial and laboratory staff served as the comparative control group. SETTING: The patients were voluntary subjects from a PD outpatients unit and were tested in their own homes. OUTCOME: The numbers of micro-organisms contaminating a connector set and entering the dialysis bag during a touch-contamination event were determined. Additionally we identified hand hygiene and, in particular, the care taken to dry the hands after washing as being highly relevant to microbial touch-contamination levels. Patient hand disinfection, as practised in most PD units, effectively reduced touch contamination to low levels. RESULTS: Touch contamination of a connector set with unprepared hands led to fewer than 100 micro-organisms translocating from fingers to the spike. If the hands were washed but not dried before touch contact was made, up to 4500 micro-organisms translocated to the connector set spike. Air-towel drying of washed hands before touch contact reduced the translocating numbers by 95%-99%. Hand disinfection, as routinely practiced by PD patients, reduced the bacterial numbers reaching the peritoneal cavity after touch contamination to <5. The range of micro-organisms isolated from the fingers of PD patients using hand disinfectants on a regular basis showed considerably more diversity than the control group. CONCLUSION: Hand care prior to bag exchange has a major effect on touch-contamination levels. Accidental touch contact of connecting devices by unprepared hands using a PD-bag exchange procedure leads to the translocation of 500 micro-organisms or fewer to the connector device. If the hands are wet at the time of contact the number translocating can be as high as 4500. Hand drying with an air towel before touch contact reduces the numbers translocating by 95%-99%. Hand disinfection procedures carried out prior to bag exchange minimizes touch-contamination levels.

Ambulatory Care↗