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Treating dental caries as an infectious disease. Applying the medical model in practice to prevent dental caries.

The above diagnostic and treatment principles may be self evident to most dental practitioners. To many, however, this treatment philosophy is a new one. Continuing dental education and quality assurance programs will play a significant role in helping dentists make the philosophical shift from a highly technical restorative approach to one that uses the medical model and treats dental caries as an infectious disease. While a total cure in humans suffering from dental disease may never be attainable, dental practitioners should soon be better able to direct more of their attention to the patients who already demonstrate a high incidence of dental decay and to those who are clearly at risk to develop future dental decay.

Communicable Disease Control↗

The Yad Sarah geriatric dental clinic, a different model.

INTRODUCTION: There are not sufficient dental services for elderly people around the world. Yad Sarah is an Israel-wide network of volunteers aiding sick, elderly, isolated and housebound people with an array of services aimed at making home care possible. It provides medical and social services to more than 380 000 elderly persons per year and in addition, lends medical equipment free of charge, has day rehabilitation centres, legal aid council for seniors, provides transportation for the disabled, meal deliveries and geriatric dental services. MATERIALS AND METHODS: The latter are equipped with five dental units (one mobile unit) and a dental laboratory. During the 5 years from 2000 to 2004 the dental services provided dental care for 3890 elderly patients with the main clinic located in Jerusalem. Patients pay an average of 70% of the cost price of their dental care, with the difference being subsidised by Yad Sarah. Of the 515 patients who applied for treatment in 2004, 54% possessed natural teeth in both jaws, 28% were fully edentulous, 12% were edentulous in the maxilla and 6% were edentulous in the mandible. Females applied for dental treatment more often than the male population. Older patients (75-101 years old) required oral care at their homes or at old age residences, more frequently than the younger age groups (60-74 years old). CONCLUSION: Dental treatment was administered by 70 volunteer dental surgeons, two certified dental hygienists and dental hygienist students. The clinical staff was provided with a comprehensive in-service training in geriatric dentistry during the 3-year service learning period. A survey in 2004 showed that 83% of the selected patients were satisfied, compared with 14% who were not. The reasons for satisfaction were, mainly, the personal relationship with the attending staff (41%) and the professional ability of the dental team (46%).

Aged↗

Evidence of the validity of a model of determinants of quality of restorative dental care.

A model describing the relationship between self-reported quality of restorative dentistry and dentist characteristics for 119 Montana general dentists is presented. The best predictors formed a significant model explaining 22% of the variance of the quality measure. Results are contrasted with a previous estimation of the model for 102 Washington general practitioners. Evidence for the external validity of the model is presented.

Adult↗

Model curriculum for forensic dentistry in US dental schools.

A model curriculum for forensic dentistry in US dental schools has been presented. This curriculum follows guidelines that will provide the dental student with practical training in specific forensic techniques, knowledge of general principles of forensic dentistry, and an appreciation for the dentist's responsibility within the legal community.

Curriculum↗

Accuracy of integration of dental casts in three-dimensional models.

PURPOSE: This study investigated errors occurring in three-dimensional (3D) models when plaster dental casts are integrated into them. MATERIALS AND METHODS: Three-dimensional milling models of three patients with a jaw deformity were fabricated using the Endoplan system (SPARC International Inc, Santa Clara, CA). After this, plaster dental casts were integrated into the 3D models using a face-bow transfer system. Two cephalograms were then compared, one obtained from the patient and the other obtained from the 3D model painted with contrast medium. RESULTS: In two cases, the reproducibility of the dental position as determined by angle analysis was within 2 degrees, and that determined by distance analysis was within 2 mm. However, errors over 4 degrees and 4.2 mm, respectively, were observed in one case. CONCLUSION: It is clinically important to confirm the accuracy of the 3D model by cephalometric analysis, and it may be necessary to reposition the dental model based on the results.

Adult↗

An articulation model to increase student enrollment in a dental hygiene program.

Models to increase student enrollment have been presented accessing both community college and university systems. While these approaches identify certain potential student consumers, the secondary and postsecondary student has not been considered as a viable recruit for baccalaureate degree programs. The purposes of this paper are to (1) present a model to access secondary students with entry-level skills using a partnership agreement; (2) establish a mechanism where dental aides are provided with opportunity for advanced placement; (3) provide ladder educational steps for advancing motivated and qualified health professionals; and (4) provide criteria for statewide development and sources of potential external funding for statewide implementation. This articulation model is an example of one method to increase student enrollment in both associate and baccalaureate degree programs utilizing an established statewide secondary vocational program.

Adolescent↗

[Orthognathic surgery and stereolithographic models. A new technic of dental occlusion transfer].

Use of stereolithographic models in orthognathic surgery is limited by the difficult in considering the facial osteotomies and the dental occlusion at the same time. Different techniques allow the surgeon to perform the simulation using composite prototypes after including the dental casts on the models. These techniques require complex "stereotaxic" systems or a surgical approach before CT scanning in order to insert the reference screws. They cannot overcome the problem of mandibular movement during the CT session. Our technique is a simple way to include the dental casts in the stereolithographic model with high precision. This can easily be done in a maxillo-facial environment and does not require any further special knowledge other than that which can be aquired in a classical dental laboratory. The occlusion transfer is achieved with a silicon cast of the teeth and the bony structures of the sterolithographic model on which we include the plaster dental casts. The silicone cast of the dental occlusion can also be used to decrease the mandibular movement during CT scanning.

Adult↗

[Artifacts in MR imaging of the temporomandibular joint caused by dental alloys: a phantom model study at T1.5].

PURPOSE: The influence of dental alloys on MRI of the temporomandibular joint was studied using a phantom model for this joint. METHODS: At 1,5 T, 15 dental alloys and 14 of their most important components were investigated acquiring sagittal (FOV: 150 mm) and transverse (FOV: 250 mm) T1-weighted SE images. In 11 cases, T1- and T2*-weighted FLASH images were measured additionally. The artifacts were assessed qualitatively as well as quantitatively, and the samples were subdivided into four artifact categories. RESULTS: Ag, Cu, Ga, In, Tl, Sn, Zn, amalgam, the precious alloys, the Au-Pd and Ag-Pd alloys showed no artifacts (category I). Minimal artifacts below 10 mm on transverse images (category II) were found for Cr, Pd, Pt and for the Ni-Cr alloy. Mn and the remaining non-precious alloys induced artifacts up to 30 mm (category III). Significant artifacts-more than 30 mm-(category IV) were caused by Ni-Cr and 18/8 wires and by Co, Fe, and Ni. T2*-weighted FLASH proved to be more susceptible for artifacts than T1-weighted SE and FLASH techniques. CONCLUSIONS: In contrast to dental alloys for fixed prosthodontics, Ni-Cr- or 18/8 wires used for orthodontic bands can influence not only the image quality, but also the diagnostic reliability of MRI of the temporomandibular joint.

Artifacts↗

An in vitro model of human dental pulp repair.

Pulp tissue responds to dentin injury by laying down reactionary dentin secreted by existing odontoblasts or reparative dentin elaborated by odontoblast-like cells that differentiated from precursor cells in the absence of inner dental epithelium and basement membrane. Furthermore, growth factors or active dentin matrix components are fundamental signals involved in odontoblast differentiation. In vitro, dental pulp cells cultured under various conditions are able to express typical markers of differentiation, but no culture system can re-create pulp response to dentin drilling. This paper reports the behavior of thick slices from human teeth drilled immediately after extraction and cultured from 3 days to 1 month. Results show that the damaged pulp beneath the cavity is able to develop, in vitro, some typical aspects correlated to tissue healing, evidenced by cell proliferation (BrdU-positive cells), neovascularization (positive with antitype-IV collagen antibodies), and the presence of functional (3H proline-positive) cuboidal cells close to the injured area. After 30 days of culture, elongated spindle-shaped cells can be seen aligned along the edges of the relevant dentin walls, whereas sound functional odontoblasts are well-preserved beneath healthy areas. This tissue recovery leads us to believe that such a culture model will be a useful system for testing factors regulating pulp repair.

Adolescent↗

Evaluation of biocompatibility of metallic dental materials in cell culture model.

Biocompatibility of metals for dental use was tested using a three-dimensional model consisting of oral keratinocytes cultured on de-epidermised sub-mucosa. The toxicity of orthodontic metallic wire and soldering material was assessed through parameters such as the morphology and growth rate of the keratinocytes, as well as by classical histology, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The sharp composition of metallic wires and soldering materials was assessed by Auger Electron Spectroscopy (AES). The results of our experiment showed that the new model revealed inhibition of keratinocyte growth and stratification near soldering material, whereas mucosal cells were able to grow and layer out on dental wire. It is concluded that this experimental model, which simulates the oral environment, is useful for studying the effects of materials for dental use for its sensibility and reproducibility. Moreover it can provide morpho-functional information which cannot be achieved by traditional methods.

Cell Culture Techniques↗

[3D solid model of mandible with dental arch via LOM method].

OBJECTIVE: Based on 3D reconstruction data from CT scanning, a solid model of mandible with dental arch is obtained via a rapid prototype machine using LOM method. METHODS: 3D reconstruction data is transferred to STL file using software of Delcam(UK),which will be fed to Magics RP software for detection and rebuilding. Reproduction of the papery model of mandible with dental arch is then performed with highly geometric similarity. RESULTS: The RP model of mandible with dental arch is obtained. CONCLUSION: Accuracy of the reproduction model meets the demands of students in prosthetic dentistry,which gives the possibility of computer aided design of prosthetic dentistry based on 3D solid model.

English Abstract↗

Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/acetaminophen/ibuprofen in acute postoperative pain: a single-center, single-dose, randomized, active-controlled, parallel-group study in a dental surgery pain model.

BACKGROUND: The combination of tramadol and acetaminophen has demonstrated good efficacy in various clinical pain models. However, there is a need for comparisons of the onset of analgesia and other measures of analgesic efficacy with this combination and other strong combination analgesics for the management of acute pain. OBJECTIVE: The goal of this study was to compare the time to onset of analgesia and other measures of analgesic efficacy with tramadol/acetaminophen 75/650 mg (Tr/Ac) and codeine/acetaminophen/ibuprofen 20/500/400 mg (Co/Ac/Ib) in the management of acute pain after oral surgery. METHODS: This was a single-center, single-dose, randomized, active-controlled, parallel-group study in healthy subjects who had undergone surgical extraction of > or =1 impacted third molar requiring bone removal. When patients reported at least moderate pain after dental surgery (score > or =5 on a 10-point scale), they were randomized to 1 of 2 treatment groups. The time to onset of analgesia was measured using a 2-stopwatch technique. The time to the onset of perceptible and meaningful pain relief, pain intensity, pain relief, patient's overall assessment, and adverse events were recorded for 6 hours after dosing. RESULTS: One hundred twenty-eight subjects participated in the study, 64 in each treatment group. The 2 groups were similar in terms of baseline pain severity and demographic characteristics (mean age, 23.7 and 23.4 years in the Tr/Ac and Co/Ac/Ib groups, respectively; mean body weight, 58.5 and 60.3 kg). The median times to the onset of perceptible pain relief were a respective 21.0 and 24.4 minutes, and the median times to the onset of meaningful pain relief were 56.4 and 57.3 minutes. Mean total pain relief and the sum of pain intensity difference were also similar in the early period after dosing (0-4 hours). However, between 4 and 6 hours, Co/Ac/Ib was associated with significant differences in both variables compared with Tr/Ac (P < 0.05). Although similar through the 4-hour assessment, mean pain intensity difference was significantly greater with Co/Ac/Ib at 5 to 6 hours. The proportion of patients assessing their assigned treatment as good or better was significantly greater with Co/Ac/Ib compared with Tr/Ac (P < 0.05). The safety profile of Tr/Ac was comparable to that of Co/Ac/Ib. CONCLUSIONS: In this small and selected group of subjects, the onset of analgesia and analgesic efficacy of Tr/Ac was comparable to that of Co/Ac/Ib. Tr/Ac provided rapid and effective analgesia for acute postoperative dental pain in this population.

Acetaminophen↗