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PubMed2003

Managing the care of patients infected with bloodborne diseases.

BACKGROUND: The emergence of the bloodborne pathogens HIV, the cause of AIDS; hepatitis B virus, or HBV; and hepatitis C virus, or HCV, has been a milestone in the history of the dental profession. In the early 1980s, new cases of AIDS increased dramatically, and fear of acquiring this disease compelled clinicians to modify the delivery of medical and dental care to allay fears of transmission on the part of both patients and health care workers. Arguably, the AIDS pandemic has been the most significant factor in the evolution and delivery of modern medical and dental care in the last century. OVERVIEW: To help ally fears and remove barriers to caring for the HIV population, the Centers for Disease Control and Prevention, or CDC, introduced the concept of universal precautions in 1983. This was followed by the Occupational Safety and Health Administration's Bloodborne Pathogens Standard in 1991. Specific to the dental profession was the development of the principles of infection control in dentistry recommended by the CDC (1993); the American Dental Association (1995) and the Organization for Safety & Asepsis Procedures (1997). While initially difficult for some clinicians to acknowledge, these recommendations now are universally accepted throughout the profession, and provision of oral health care to patients infected with bloodborne disease is becoming commonplace. Compliance with recommended infection control practices remains an important component of dental practice. But it must be accompanied by an understanding of infectious and bloodborne diseases and the medical/dental management of the care of infected dental patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The emergence of the bloodborne pathogens and the increasing number of infected patients who seek oral health care compel clinicians to have a thorough knowledge about bloodborne diseases and the medical/dental management of the care of patients presenting with HIV, HBV or HCV infection.

Blood-Borne Pathogens↗
PubMed2004

A three-year clinical evaluation of two dentin bonding agents.

BACKGROUND: A new restorative called a "giomer composite" has been introduced. The authors conducted a study to determine retention, anatomical form, caries, staining, marginal discoloration, marginal adaptation, surface roughness and sensitivity of giomer compared with those of a microfilled composite. METHODS: The authors placed 40 sets of restorations randomly in canines and premolars in vivo. They used a giomer composite and a microfilled composite in erosion/abrasion/abfraction Class V lesions that were not altered with rotary instruments. They placed the restorations according to manufacturer's recommendations, and two calibrated examiners evaluated the restorations independently using modified U.S. Public Health Service criteria at baseline and at six, 18 and 36 months. The lesions receiving the restorations did not differ from each other in the amount of circumferential enamel present, the percentage of the surface area of dentin or lesion type. RESULTS: There were no differences in the restorations at baseline, an evaluation made two weeks after placement. At 36 months, the giomer and microfilled composite restorations were not significantly different from one another in any of the eight criteria evaluated. The percentage agreement between examiners was at least 83 percent for each criterion in each evaluation period. CONCLUSIONS: Both the giomer and the microfilled composite used in this study meet the clinical portion of the Acceptance Program Guidelines for Dentin and Enamel Adhesives Materials established by the American Dental Association. CLINICAL IMPLICATIONS: Both the giomer and the microfilled composite used in this study can be used with confidence in Class V lesions.

Adult↗
PubMed2004

Inventory management.

As dentistry continues to evolve, the best management systems of the business world need to be incorporated into each practice. As always, my goal in these columns is to bring and modify the best business principles available to readers of The Journal of the American Dental Association. Just in Time ordering and inventory control is one of the best, as evidenced by the fact that top-performing companies worldwide have adopted it.

Cost Control↗
PubMed2004

A simulated-use evaluation of a strategy for preventing biofilm formation in dental unit waterlines.

BACKGROUND: Prevention of biofilm formation is important in the maintenance of dental unit waterline systems. Without effective control measures, the waterlines will become contaminated with routine use. METHODS: The authors used a simulated-use dental unit waterline system to evaluate the ability of a test product, A-dec ICX (A-dec, Newburg, Ore.), to prevent biofilm formation. They evaluated buffered distilled water and hard water models versus mixed-challenge suspensions of Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. RESULTS: The authors documented development of significant biofilm in untreated test units, while treated test units showed no indication of biofilm formation throughout the 16-week study. Student t tests and 95 percent confidence intervals performed on the plate count data confirmed that untreated test units had significantly greater bacterial populations than did treated test units (P < .05). Qualitative images by scanning electron microscopy verified these findings. CONCLUSION: In this simulated clinical-use study, the test product effectively reduced bacterial counts in incoming water and produced water quality exceeding stated recommendations of the American Dental Association. CLINICAL IMPLICATIONS: The test product provides an approach to dental unit waterline maintenance that is simple to use and that, by continuously preventing biofilm formation, reduces concerns about bacterial contamination in dental unit water.

Biofilms↗
PubMed2004

Trends in dental and allied dental education.

BACKGROUND: Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force. OVERVIEW: This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase. CONCLUSIONS: Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs. PRACTICE IMPLICATIONS: Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

Costs and Cost Analysis↗
PubMed2004

Severe acute respiratory syndrome and dentistry: a retrospective view.

BACKGROUND: Severe acute respiratory syndrome, or SARS, which has created panic in Asia and in some parts of North America, is the first epidemic of the new century. Although it has been well-contained, sporadic cases continue to emerge. OBJECTIVES: The authors trace the emergence of the SARS outbreak from southern China and its spread worldwide, discuss the viral etiology of the infection and its clinical features, and review the infection control guidelines issued during the outbreak by the health authorities in Hong Kong, the Centers for Disease Control and Prevention, the World Health Organization and the American Dental Association. They also review the prospects for a new outbreak and preventive measures. OVERVIEW: The disease, which is caused by a novel coronavirus termed the "SARS coronavirus," or SARS-CoV, essentially spreads through droplet infection and affects people of any age. It has a mortality rate ranging from 10 to 15 percent. A major hallmark of this disease has been the rate at which it has affected health care workers through nosocomial transmission; in some countries, up to one-fourth to one-third of those infected were in this category. However, no dental health care worker has been affected by SARS in a nosocomial or dental setting. CONCLUSIONS AND CLINICAL IMPLICATIONS: Researchers believe that a combination of factors, including the universal infection control measures that the dental community has implemented and/or the low degree of viral shedding in the prodromal phase of SARS, may have obviated the spread of the disease in dental settings. The dental community should reflect on this outbreak to reinforce the currently applied infection control measures.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Specialty and sex as predictors of depression in dentists.

BACKGROUND: Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists. METHODS: The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week. RESULTS: The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P < .001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment. CONCLUSIONS: The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment. CLINICAL IMPLICATIONS: Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.

Adult↗
PubMed2005

On the primary care frontlines: the role of the general practitioner in smoking-cessation activities and diabetes management.

BACKGROUND: Advances in understanding the relationship between oral disease and systemic conditions need to be translated into clinical practice. Relevant here is assessing dentists' active involvement in in-office smoking-cessation activities and management of the patient with type 1 or type 2 diabetes. METHODS: The authors mailed a survey to a net sample of 132 active general practitioners (GPs) in the northeastern United States during fall 2002. They drew a random sample of GPs listed in the designated states from the 2001 American Dental Association directory. They received 105 responses, for a response rate of 80 percent. RESULTS: With regard to smoking-cessation activities and management of diabetic patients, a majority of GPs reported having a lack of knowledge, viewed such activities as peripheral to their role and disagreed that colleagues and/or patients expected them to perform such activities. More GPs performed both activities on an assessing/advising basis than on an active management basis. CONCLUSION: Results suggest that approaches to changing dentists' behavior should aim not only at increasing knowledge but at overcoming attitudes and orientations associated with actively managing patients who smoke and patients who have diabetes. PRACTICE IMPLICATIONS: The profession's growing evidence base supports an increased primary and preventive care role for dentists. This role affords them opportunities to expand the bounds of dental practice, improve therapeutic outcomes and promote patients' overall health.

Attitude of Health Personnel↗
PubMed2006

Measuring the validity of two in-office water test kits.

BACKGROUND: The authors conducted a study to determine the validity of two commercially available in-office water test kits compared with a spread plate technique using the gold standard dehydrated culture medium R2A agar for monitoring the quality of dental treatment water. METHODS: Over a 12-week period, one author monitored nine dental units in a dental school that each were equipped with an independent water reservoir. The author collected 351 split samples, cultured them using three test methods, counted bacterial colonies manually and assessed validity using two cutoff values: < or = 200 colony-forming units per milliliter (CFU/mL) (an American Dental Association goal) and < or = 500 CFU/mL (a Centers for Disease Control and Prevention [CDC] recommendation and a U.S. Environmental Protection Agency [EPA] mandate). RESULTS: Of the 351 split samples processed, the in-office test kits' accuracy ranged from 25 to 69 percent, according to the ADA and CDC/EPA recommendations, compared with the R2A agar. CONCLUSIONS: Overall, the in-office test kits underestimated bacteria levels, producing inaccurate measurements of bacterial levels compared with the R2A agar. CLINICAL IMPLICATIONS: The data suggest that use of the two in-office test kits could result in a lack of compliance, owing to underestimating bacterial contamination with recognized recommendations for dental unit waterline quality.

Colony Count, Microbial↗
PubMed2005

Use of statistical procedures in Brazilian and international dental journals.

A descriptive survey was performed in order to assess the statistical content and quality of Brazilian and international dental journals, and compare their evolution throughout the last decades. The authors identified the reporting and accuracy of statistical techniques in 1000 papers published from 1970 to 2000 in seven dental journals: three Brazilian (Brazilian Dental Journal, Revista de Odontologia da Universidade de Sao Paulo and Revista de Odontologia da UNESP) and four international journals (Journal of the American Dental Association, Journal of Dental Research, Caries Research and Journal of Periodontology). Papers were divided into two time periods: from 1970 to 1989, and from 1990 to 2000. A slight increase in the number of articles that presented some form of statistical technique was noticed for Brazilian journals (from 61.0 to 66.7%), whereas for international journals, a significant increase was observed (65.8 to 92.6%). In addition, a decrease in the number of statistical errors was verified. The most commonly used statistical tests as well as the most frequent errors found in dental journals were assessed. Hopefully, this investigation will encourage dental educators to better plan the teaching of biostatistics, and to improve the statistical quality of submitted manuscripts.

Bibliometrics↗
PubMed2006

Water sorption of heat-polymerized acrylic resins processed in mono and bimaxillary flasks.

This study evaluated water sorption in heat-polymerized acrylic resins processed in monomaxillary flasks by water bath and in bimaxillary flasks by microwave energy and water bath. Fifty heat-polymerized acrylic resin specimens were fabricated according to the 12th specification of the American Dental Association and assigned to 3 groups: group 1 was processed by water bath in monomaxillary metallic flask; group 2 was processed by microwave energy in bimaxillary PVC flask; and group 3 was processed by water bath in bimaxillary metallic flask. Specimens were submitted to water sorption test, means were calculated and analyzed statistically by Student's t-test. Means (in g/cm3) were: group 1--0.024085, group 2--0.025312 and group 3--0.022098. Microwave energy processing and the amount of stone and resin used in the bimaxillary PVC flask did not influence water sorption; specimens processed in bimaxillary metallic flask by water bath presented lower water sorption means, suggesting an inadequate polymerization of the acrylic resin mass.

Absorption↗
PubMed1991

Clinical and microbiological effects of a sanguinaria-containing mouthrinse and dentifrice with and without fluoride during 6 months of use.

The purpose of this study was to test the efficacy and safety of sanguinaria-containing regimens with and without fluoride using the American Dental Association guidelines for evaluating chemotherapeutic agents. The study was a 6-month, double-blind, 4-cell, placebo-controlled, parallel investigation involving 120 subjects. Following screening procedures, subjects were randomly assigned to 4 groups. Group 1 received a dentifrice containing 0.075% sanguinaria extract (SaE) and 2.0% zinc chloride (ZnCl2) in a dicalcium phosphate base, plus an oral rinse containing 0.03% SaE and 0.2% ZnCl2. Group 2 received identical products without SaE or ZnCl2. Group 3 received a dentifrice containing 0.8% sodium monofluorophosphate, 0.075% SaE, and 0.05% ZnCl2 in a silica base, plus an oral rinse containing 0.03% SaE and 0.2% ZnCl2. Group 4 products were identical to those of Group 3 but without SaE and ZnCl2. Supragingival plaque and gingival inflammation were scored at 0, 1, 2, 1.5, 3, 4.5, and 6 months; bleeding upon probing was measured at 1, 1.5, 3, and 6 months. Microbiological samples were taken from plaque, tongue, and cheek areas. The active products produced statistically significantly lower scores than the placebo agents for all indices (P less than .0001). Six-month plaque scores were 13.1% lower for Group 1 and 17.4% lower for Group 3 compared to placebo products. When the Plaque Severity Index was applied, the percentage reductions were 33% for Group 1 and 41% for Group 3 compared to placebos. Gingival inflammation scores were 16.7% lower for Group 1 and 18.1% lower for Group 3 at 6 months compared to placebo scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Six-month comparison of powered versus manual toothbrushing for safety and efficacy in the absence of professional instruction in mechanical plaque control.

BACKGROUND: Reports suggest powered toothbrushing may provide some clinical benefit over manual tooth-brushing, but most studies have been of short duration with subjects trained in toothbrush use. The aim was to determine if the oscillating-rotating powered brush (PB) could safely provide clinical benefits over and above a manual brush (M) in subjects with no formal instruction or experience in powered brush use. METHODS: This 6-month, single-masked, parallel design, randomized clinical trial compared the PB with an American Dental Association (ADA)-accepted soft-bristle manual brush in a non-flossing gingivitis population (n = 157). Subjects were given written instructions but no demonstration on toothbrush use at baseline. Efficacy was assessed by changes in gingival inflammation, plaque, calculus, and stain, while changes in clinical attachment levels and recession measurements provided safety data. A prophylaxis was provided after baseline assessment. The 6-month plaque index (PI) was recorded immediately post-brushing after covert timing of the subjects, and correlation analyses were run to assess the relationship of brushing time to PI. Paired t tests, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used to assess within and between treatment group differences for PB (n = 76) versus M groups (n = 81). RESULTS: Measures of inflammation showed a statistically significant drop for both brushes at 3 and 6 months. Mean overnight full-mouth PI scores were significantly lower at 3 months for the PB (1.57) compared to the M group (1.80), P = 0.0013. Immediate post-brushing PI at 6 months was also significantly lower for the PB (1.10) versus M (1.39) (P= 0.0025). There was an overall negative correlation for PI and brushing time (r = -0.377, P= 0.0001). Mean calculus index (CI) scores were lower for the PB at 3 (P= 0.0304) and 6 months (P = 0.0078), while no significant differences in stain were observable. Clinical attachment level and recession measurements showed no significant between-group changes from baseline for either brush on canine teeth or on teeth with recession at baseline. CONCLUSION: The oscillating-rotating toothbrush safely provides clinical benefits in plaque and calculus reduction over a manual brush even in subjects with no formal oral hygiene instruction.

Adolescent↗
PubMed2004

The comparative efficacy of stabilized stannous fluoride/sodium hexametaphosphate dentifrice and sodium fluoride/triclosan/copolymer dentifrice for the control of gingivitis: a 6-month randomized clinical study.

BACKGROUND: Antimicrobial agents such as stannous fluoride and triclosan have been incorporated into dentifrice formulations and have been shown to be effective in reducing gingivitis. The objective of this study was to compare the anti-gingivitis efficacy of a 0.454% stannous fluoride/sodium hexametaphosphate dentifrice to a positive control triclosan/copolymer dentifrice. METHODS: This was a 6-month, randomized, double-masked, parallel-group study conducted according to the American Dental Association guidelines for evaluating chemotherapeutic products for the control of gingivitis. A 0.454% stannous fluoride/sodium hexametaphosphate dentifrice was tested against a commercially available positive control dentifrice (0.30% triclosan/2.0% Gantrez copolymer). Following baseline measurements, subjects received a dental prophylaxis. Subjects were then instructed to brush twice daily for 60 seconds using their assigned product. Tooth brushing was supervised for 3 days of each week. Clinical examinations using a gingival index were performed at baseline and at 3 and 6 months. RESULTS: A total of 199 subjects were enrolled and 186 completed the 6-month study. Average baseline gingivitis and bleeding scores were similar for the two treatment groups. After 6 months, the experimental group had statistically significantly less gingivitis (25.8%) and statistically significantly less bleeding (27.4%) on average compared to the control group. Neither adverse oral soft tissue effects nor tooth staining were reported. CONCLUSION: Within the limits of the study protocol, the results demonstrated superior therapeutic benefits for the stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice in reducing gingivitis compared to the triclosan/copolymer control in this partially supervised study.

Adolescent↗
PubMed2006

Fundamentals of electrocardiography interpretation.

The use of dynamic electrocardiogram (ECG) monitoring is regarded as a standard of care during general anesthesia and is strongly encouraged when providing deep sedation. Although significant cardiovascular changes rarely if ever can be attributed to mild or moderate sedation techniques, the American Dental Association recommends ECG monitoring for patients with significant cardiovascular disease. The purpose of this continuing education article is to review basic principals of ECG monitoring and interpretation.

Action Potentials↗