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PubMed1988

The use of flumazenil as an antagonist to midazolam in intravenous sedation for dental procedures.

The efficacy of flumazenil was tested in a double-blind placebo controlled study of 40 patients undergoing dental procedures. Flumazenil recipients were less sedated at 5 and 30 min post-operatively (P less than 0.001), were better oriented at 5 min (P less than 0.001) and 30 min (P less than 0.01) and were more co-operative at 5 min (P less than 0.001) and 30 min (P less than 0.005). None of the patients in either the placebo or flumazenil groups could remember operative events. The dental surgeon felt that flumazenil made recovery in the supine position unnecessary and made post-operative monitoring easier. Flumazenil is a drug that should be included in the armamentarium of any emergency drug kit when benzodiazepines are used i.v.

Adolescent↗

PubMed1990

The use of rubber dam in the UK. A survey.

The purpose of this survey was to determine the frequency of use of rubber dam isolation in the United Kingdom for both operative and endodontic procedures. Questionnaires were sent to 1800 dentists throughout the country, with 1008 returns (56%). Most replies were from dentists active in general dental practice. The use of rubber dam is largely neglected and more than 70% of all dentists surveyed did not utilise rubber dam for any procedure whatsoever.

Age Factors↗

PubMed2005

A survey of demand for specialist restorative dental services.

OBJECTIVES: To determine the level of demand from general dental practitioners (GDPs) for specialist restorative dental services in the Yorkshire region. To investigate barriers and promoters to referral and GDPs' perceptions of restorative mono-specialists. METHODS: A postal questionnaire was sent to 301 randomly selected GDPs (stratified for location) registered in the six Family Health Service Units in Yorkshire. Questionnaires were piloted prior to release; reminders were sent to non-respondents. RESULTS: A response rate of 72% (n=217) was achieved, of these 195 questionnaires were useable (65% useable response rate). Results showed a large demand for restorative specialist services. Main promoters for National Health Service (NHS) referral were dentolegal issues (77% GDPs ranked this as a top three promoter) and for private referral increasing patient expectations (78%). The top barriers against referral were length of waiting lists for NHS patients (79% GDPs ranked this as a top three barrier) and high cost of treatment for private patients (88%). Excessive distance to specialist centre was the greatest barrier common to both NHS and private referrals. Fifty-eight per cent of GDPs would prefer to refer private patients to mono-specialists, compared with 5% who would prefer restorative specialists. CONCLUSIONS: There is a strong demand for specialist restorative services which may increase in the future. Results indicate a high regard for mono-specialists. Overall demand is for a prompt, locally based, low cost referral service.

Attitude of Health Personnel↗

PubMed1984

An advanced clinical trial with laser acupuncture anesthesia for minor operations in the oro-maxillofacial region.

For the purpose of improving acupuncture and acupressure anesthesia, laser acupuncture as a new type of controlled anesthetic method has been used since 1979. A beam from a 2.8-6 mW helium-neon laser apparatus (Model CW-12, Chengdu Thermometer Factory) was delivered and focused to a red spot on the selected skin point of the patient. The laser was used instead of the routine acupuncture and acupressure anesthesia. This paper reports the clinical laser trial of 610 cases (562 cases of difficult exodontia and 48 cases of various minor operations in the oro-maxillofacial region). The effect of analgesia was satisfactory. No sedatives or analgesics were administered before or during operations. The helium-neon laser apparatus, selection of laser irradiating acupuncture points, distance, and duration of irradiation and clinical observations are described.

Acupuncture Therapy↗

PubMed1978

Evaluation of student performance in the four-year study of expanded functions for dental hygienists at the University of Iowa.

A comparison was made of the quality of selected operative and periodontal procedures completed by expanded-function dental hygiene and senior dental students. Each student group included 48 students selected from all academic quartiles of their respective classes. The evaluated operative procedures included a Class II preparation and amalgam restoration and a Class III preparation and composite restoration. Both operative procedures were completed twice, once on a patient and once on a Dentoform. The periodontal procedures were completed on patients and included a periodontal examination, a periodontal treatment plan, and one quadrant of root planing and soft tissue curettage. Three examiners independently rated each student's performance in an examiner-blind situation. Examiners judged numerous criteria for each procedure as satisfactory or unsatisfactory. In addition, an overall rating of excellent, clinically acceptable, or unacceptable was given to each procedure. Comparisons between student groups of the time required to complete procedures showed that dental students completed cavity preparations of all operative procedures and quadrants of root planing and curettage in significantly less time than did dental hygiene students. For restorations, periodontal examinations, and treatment plans, there was no significant difference between student groups in the time required to complete procedures. In general, the results of the study showed that the dental hygiene students were able to perform selected operative and periodontal procedures at a comparable level to that of senior dental students.

Clinical Competence↗

PubMedDate not supplied

A clinical evaluation of the electric pulp tester as an indicator of local anesthesia.

Local anesthesia is the primary method in dentistry to control patients' pain. However, several studies have shown that profound anesthesia is not always achieved. The electric pulp tester has been used to measure the level of local dental anesthesia during endodontic therapy. However, no study has been performed that evaluates the ability of the electric pulp tester to predict the efficacy of local anesthesia prior to as operative procedure. If ineffective anesthesia could be predicted, supplemental injections could be administered to alleviate the anesthetic problem. The purpose of this study was to evaluate the ability of the electric pulp tester to measure the level of local anesthesia prior to operative treatment. The study was performed in vivo on patients requiring operative therapy. All teeth were pulp tested preoperatively for vitality using the electric pulp tester. After injection of local anesthetic, traditional parameters of dental anesthesia were verified (lip numbness, mucosal sticks). Teeth were then retested with the electric pulp tester and the results recorded. The teeth were them prepared for restoration using conventional instrumentation, and the patient's level of anesthesia evaluated using a visual analog scale. The electric pulp tester readings were compared to the patient's responses using Fisher's Exact test (two-tail). The results indicate that the electric pulp tester can be a valuable tool in predicting potential anesthetic problems in operative (restorative) dentistry.

Adolescent↗

PubMed1996

[Not Available].

The present study deals with the reconstruction of the mandible on jaw and face injured soldiers in the First World War. The central element of the reconstruction - the bone transplantation - is described on various treatment methods carried out by 66 european surgeons and dentists. The main part of the study shows which kind of material and which operation technique they used and the results they achieved. The end of the study points out the importance of the bone transplantation concept used between 1914 and 1918. By the year 1914, no concept existed for the reconstruction of destroyed mandible. Only through the First World War experience did the free bone transplantation become the best concept of repairing the lower jaw. Shortly after the beginning of the war, the surgeons roughly knew how to get a solid result. Nevertheless, the operators did not fully understand why bone healing could sometimes be established and sometimes not. Only Carl Partsch from Germany assumed that the fracture healing depended on the tight contact between undamaged surfaces of stumps and transplantation pieces.

Dentistry, Operative↗

PubMed2002

Repair versus replacement of defective direct composite restorations in teaching programmes in United Kingdom and Irish Dental Schools.

The teaching of the repair of direct composite restorations has been surveyed in United Kingdom and Irish dental schools. Based on a 100% response rate, the findings indicate that the vast majority of undergraduate students in United Kingdom and Irish dental schools are taught and gain clinical experience in the repair of direct composite restorations. There is general conformity with respect to the teaching in relation to operative techniques and materials used.

Acid Etching, Dental↗

PubMed1992

A clinical evaluation of glove washing and re-use in dental practice.

This study has assessed the durability of four brands of latex gloves, Ansell Medical 'Medi-Grip', Regent 'Biogel D', Surgikos 'Microtouch' and the London Rubber Company 'Supreme', under conditions of repeated washing and re-use in a clinical dental setting. The microbiological effectiveness of 'Hibiscrub' as a decontaminating washing agent was examined simultaneously. Examination by an electrical test for micropunctures in 200 unused gloves of each brand revealed such defects in 6(3%) of Ansell 'Medi-Grip', 3(1.5%) of 'Biogel D', 14(7%) of Surgikos 'Microtouch' and 2(1%) of LRC 'Supreme' gloves. Following repeated clinical use, micropunctures were detected in 18% of Ansell 'Medi-Grip', 10% of 'Biogel D', 75% of Surgikos 'Microtouch' and 56% of LRC 'Supreme'. Microorganisms were isolated from the glove surfaces after 45% of the occasions on which the gloves were washed for 1 min in 'Hibiscrub' (ICI Dental). Eighty-five per cent of these isolates were environmental organisms, but oral streptococci were isolated from 8.4% of the pairs of gloves examined. The high rate of micropuncture development following repeated washing and re-use of latex gloves indicates that they cannot effectively perform their barrier function under such conditions. The microbiological data have also revealed the potential for cross-infection between patients through inadequate decontamination of glove surfaces. For operative dental surgery, the results suggest that heavier, surgical type gloves are to be preferred, and that multiple use of any glove type should be discouraged.

Bacteriological Techniques↗

PubMed1994

The use of logistic discrimination and receiver operating characteristics (ROC) analysis in dentistry.

Logistic regression is a statistical method which allows an investigator to 'explain' or 'predict' a binary response variable from a set of independent variables. In particular, it may be used to classify persons for example, as diseased or healthy, high risk or low risk etc. (logistic discrimination). During recent years this method has been of increasing interest and importance in dentistry. Since this demanding statistical method may not be easily accessible to dentists, a description is provided of its basic characteristics in an introductory and condensed form. A worked example, 'identification of children with high caries risk', is presented in order to demonstrate the application and use of the method. Following the presentation of the logistic model, evaluation of the performance of a classification model by means of 'receiver operating characteristic (ROC) analysis' is demonstrated. The presentation of these statistical tools here, puts more weight on verbal explanation and on graphical representations than on mathematical details. This statistical tools here, puts more weight on verbal explanation and on graphical representations than on mathematical details. This may help to make the methods accessible to readers who have insufficient time to study a more comprehensive discourse.

Child↗

PubMedDate not supplied

Painless pediatric local anesthesia.

This clinical report presents a technique for painless palatal/lingual infiltrations for pediatric patients. When treating a young child, pain control is very important in order to gain the patient's cooperation. Procedures such as clamp placement, operative techniques, pulp therapy, and extractions cause discomfort, some more than others, requiring profound anesthesia. However, achieving profound anesthesia painlessly in the palatal and lingual aspects is difficult.

Anesthesia, Dental↗

PubMed1989

Speed variability of air-driven motors in the self-threading pin technique.

Effective pin placement is dependent upon correct preparation of the dentine channel. Various factors contribute to the success or otherwise of this channel preparation. One such factor is the rotational speed of the twist drill. It is widely recommended that the twist drill be operated within the 500-800 rpm speed range, in order to prevent a temperature rise in the pulp during the cutting process. This paper examines the ability of air-driven dental motors, when coupled to two speed-reduction handpieces with differing reducing ratios, to operate within this range. The results reveal a wide variation in the speed ranges of the motors tested. Of the two types of handpiece examined, it appears that a 10:1 speed reduction is appropriate for the majority of motors.

Dental Pins↗

PubMed2000

[The operating microscope in dental general practice].

The great advantages of using a stereoscopic operating microscope in endodontics and especially in endodontic surgery are being increasingly advocated in postgraduate training courses and numerous publications. Widely underestimated, however, is the fact that this tool may open new horizons to almost all dental specialities and will improve ergonomics of the dental work place. Moreover, the superb images may contribute some pleasure to the daily dental work and stress. All this makes the clinical stereoscope interesting also for the general practice of dentistry. The purpose of this paper is to report about several years of practical experience with the "scope" in general dentistry. Technical aspects are discussed as well as the possibilities of use. Practical hints regarding the type of scope and the technique of its use are given in order to lower the barrier of entrance into this new era of doing dental work.

Dentistry, Operative↗

PubMed1986

Acute hepatitis B in patients in Britain related to previous operations and dental treatment.

The frequency of transmission of hepatitis B virus infection from health service staff to patients was assessed from reports of confirmed cases of acute clinical hepatitis in 1980-3. During the four years 4505 reports (91% of the total) included replies to a question about recent operations; 153 patients (3.4%) had this history. Transfused blood or blood products were considered the source for 27 cases (0.06%). Eleven patients (0.02%) were infected in two clusters, both in cardiac surgery units; six were caused by a perfusion technician, who was a symptomless carrier, and five by a surgical registrar during the incubation period of an acute hepatitis B infection. The estimated average annual risk of a patient developing acute hepatitis B as part of a cluster caused by staff during surgical procedures was one in a million operations. For another 11 patients blood transfusion could not be excluded as a source. Where no association between surgery and hepatitis was found the incidence of a history, lay between 2.3 and 2.6%. The Hospital In-Patient Enquiry data showed that about 2.4% of the population had had operations in a six month period. These findings suggest that transmission of hepatitis B infection from staff to patients is rare in Britain and that the small risk could be eliminated by attention to measures to preserve asepsis and by immunising staff at risk.

Adolescent↗

PubMed2005

Contemporary treatment of incipient caries and the rationale for conservative operative techniques.

This article provides evidence to support the use of more conservative cavity preparation techniques with adhesive restorative resins. The authors discuss the issue of conservative operative techniques related to hidden or occult caries. The support for contemporary technology also concerns methods of caries detection and the role of magnification, caries risk assessment of the patient, conservative caries management, instrumentation, materials, and techniques.

Air Abrasion, Dental↗

PubMed1990

The incidence of undiagnosed punctures in non-sterile gloves.

This study investigates the incidence of undiagnosed punctures in five types of single and multiple patient use gloves worn by a group of practitioners (n = 6) in general and hospital practice, and provides data on the incidence of undiagnosed punctures in gloves worn on operative and passive hands. Gloves considered to be intact when discarded (n = 510, 85%) were examined for undiagnosed punctures by water inflation. The incidence of undiagnosed punctures varied considerably with glove type (range 3-49%) and among the practitioners (range 9-29%), and some gloves, notably the vinyl type investigated, appeared to be more prone to puncture than the other types of glove. More than 60% of the undiagnosed punctures were in the thumbs and second fingers of the gloves. The incidence of undiagnosed punctures in gloves from operative hands was only slightly greater than that for gloves from passive hands. The gloves intended for multiple patient use were found to have the lowest incidence of undiagnosed punctures. However, the single patient use gloves were typically misused, in that they were worn during the treatment of more than one patient.

Dentistry, Operative↗

PubMed1990

Operating illumination to differentiate dental hard tissues.

This in vitro study was designed to evaluate the ability of fluorescent tubes and dental lights to help operators distinguish tissues (fissures), differentiate between tissues (at the dentinoenamel junction or between carious and sound dentin), and distinguish form of a tooth preparation (Class II and Class V cavities). Operators with "normal" color vision ranked the lights in order of preference for each type of specimen. In general, for the fluorescent illuminants, operators preferred lights with high color temperature values and high color rendering index values. A small group of color-blind observers indicated a preference for an illuminant of low color temperature and low color rendering index value. For dental lights, operators preferred a higher color temperature for examining fissures, the dentinoenamel junction, and the cavity preparation. No particular illuminant was preferred for distinguishing between carious and sound dentin. Many observers had difficulty in choosing a preferred dental luminaire.

Color↗

PubMed2005

Blood pressure, heart rate and temperature variability during periodontal surgery.

The aim of the present study is to investigate changes in blood pressure, pulse rate and temperature before and after periodontal surgery. The study included 127 normal healthy patients (43 males, 84 females) with age range 9 to 65 years (mean age: 26 +/- 12 years) who underwent periodontal surgery. After administration of a local anaesthetic agent (Ultracain DS) containing 0.06 mg adrenaline, the blood pressure, pulse rate, and temperature were measured. Based on the type of operation, the patients were divided into four groups. Statistically significant changes (as decreasing) in all parameters were observed (blood pressure: systolic 111.3 +/- 20.1, diastolic 67.7 +/- 13.1, pulse rate: 87.8 +/- 14.9, temperature: 36.3 +/- 0.3 ) but these changes were significantly decreased after operations (blood pressure: systolic 105.9 +/- 19. 7, diastolic 62.6 +/- 11.3, pulse rate: 84.01 +/- 13.1, temperature: 36.2 +/- 0.3). And without age group differentiation in all parameters, statistically significant decreases were found among females (p < or = 0. 05).

Adolescent↗