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In a busy dental practice the many advantages of the routine use of dental dam for day-to-day procedures are often not appreciated. Many general dental practitioners (GDPs) are unaware of the simple and rapid techniques for placement that exist and the important role that rubber dam plays in infection control.
This article aims to introduce the reader to the use of magnification in clinical dentistry and describes the lens systems available. The main principles of dental loupes are discussed and some of the potential problems outlined in order to help clinicians choose a magnification suited to their needs, provide years of service, and reduce the risk of eye, neck and back strain. The additional benefits and disadvantages of adding supplementary illumination, and the options available, are also considered.
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The management of adult dental patients with congenital bleeding disorders has caused a considerable number of problems to the dental profession. There is a need to simplify the process and identify what can be safely carried out on a 'shared care' basis in General Dental Practice or the Community Dental Service. Particular problems are discussed with special reference to those requiring hospital care. The Scottish Oral Health Group for Medically Compromised Patients has developed this clinical guidance in conjunction with the Scottish Haemophilia Directors. It is important that dental care is easily available for this group of patients, especially those living at some distance from the regional centres. The aim is to simplify planning dental care for this group of patients and remove a number of myths concerning their management. The hospital departments, both medical and dental, must be available for advice and to arrange for treatment that is inappropriate outside a specialist hospital.
A modified laryngeal mask airway was used to facilitate nasotracheal intubation with a fibreoptic laryngoscope. A size 4 laryngeal mask airway was modified by creating a defect at the base of the stem and removing the bars to allow passage of the fibreoptic laryngoscope from the nasopharynx to the larynx. The laryngeal mask airway cuff was split and the cut edges were sealed with silicone. This design allowed the cuff to function normally and allowed removal of the split laryngeal mask airway after the tracheal tube had been 'railroaded' into place. Thirty-four patients were studied. The split laryngeal mask airway was easily inserted with satisfactory airway maintenance in 32 patients. Nasal airway endoscopy and laryngoscopy were successfully achieved with the split laryngeal mask airway in place in 31 of 32 patients. Railroading the tracheal tube over the fibreoptic laryngoscope with the split laryngeal mask airway in place was successful in all 31 of these patients. This prototype split laryngeal mask airway allows good airway maintenance while fibreoptic nasotracheal intubation is performed.
A postal survey of NHS hospital-based anaesthetists providing out-patient anaesthesia for dental procedures in children under 10 years of age was conducted in February 1999. Information was sought about quality of care and common practice in Scotland. The experience of the anaesthetists involved in such work was substantial, but the monitoring used did not meet current standards, with only 16% of respondents indicating use of a full range of standard devices. Separate recovery facilities were available to 99%, and all had access to a defibrillator, but the qualifications of dedicated assistant and recovery staff were lacking in 14 and 30%, respectively. Intravenous access was not obtained routinely after inhalational induction of anaesthesia by up to 71% (49%, never; 22%, sometimes). Systemic analgesia or local anaesthesia was used by 88%. Discharge times ranged from 10 min to 6 h.
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We tested the response to desmopressin (1-deamino-cys-8-D-arginine-vasopressin; DDAVP) in four patients with haemophilia B [factor IX (F IX) at diagnosis 1.4-5%]. The activated partial thromboplastin time (aPTT) was significantly shortened in all patients. Although there was an up to 1.4-fold increase in F IX levels in three patients, maximal F IX activity remained below 10%. Much more prominent were the increases in F VIII (three- to fourfold), in von Willebrand factor antigen (VWF:Ag; 2.5-fold) and particularly in VWF collagen-binding activity (VWF:CBA; fivefold). These changes were reflected by the prophylactic efficacy of DDAVP for dental surgery. After pretesting, DDAVP could be a useful drug for reducing the need for plasma products for prevention of minor surgical bleeding in patients with mild to moderate haemophilia B.
'Aspects of Minor Oral Surgery' is a highly interactive software program that was commissioned by the Department of Health, England, as part of the continuing education opportunities of general dental practitioners. The content of the program is also suited to the education of senior clinical dental students. The beta (pre-release) version was evaluated by 67 general dental practitioners, who completed a questionnaire on aspects of the program's functionality. Responses on its usefulness as an educational tool were 78% positive and 4% negative. In comparing the program to other educational media on the same subject, 77% felt it was better than video, 69% said it was better than textbooks, and 80% preferred it to journals. Its main strengths were judged to be the high level of interactivity, the ease of navigation and use, and the quiz section. The quality of the images of surgical procedures displayed in the slide shows was judged to be a weakness, and this problem was addressed in preparing the final version. Ten UK academic and four health service senior oral surgeons were also asked to give feedback on the program's content, and these points were also incorporated in the final text. More than 1,600 copies of the program have been taken up by general dental practitioners so far. The program may be downloaded for evaluation via the internet.
OBJECTIVES: To investigate the values and practices of assessment of the clinical practice of dental students by a sample of teachers in restorative dentistry. DESIGN: A questionnaire, based on the above objectives, was designed, piloted and redesigned. Its content was based on evidence-based good practice in assessment. Structured items in the questionnaire required responses on (i) frequency of use and (ii) estimates of value of various approaches and characteristics of the assessment systems that respondents were using. SETTING: The 14 undergraduate dental schools of the United Kingdom. SUBJECTS: Full-time clinical teachers of restorative dentistry in adults (comprising conservation (including endodontics), periodontology and prosthodontics). RESULTS: A total of 153 usable questionnaires were returned (response rate 70.8%), and 38 statistically significant differences were reported (of which 35 were very highly significant), based on the correlated t statistic. Values were in line with evidence-based good practice, but practices were not in line with values. Particularly noteworthy were the high values attached to objective structured clinical examinations, self- and peer-assessment, portfolio-based learning, feedback to students, the use of objective criteria, communication skills and oral health education. The corresponding frequency of usage of these aspects was relatively low. The reported aims of courses in restorative dentistry were not matched by the profile of assessment practices. CONCLUSIONS: The findings have implications for the development of student learning, assessment procedures and the management of quality and enhancement of dental programmes. Although this is a report of only one study, it relates to the major clinical component of undergraduate programmes in dentistry. The findings imply that the time is ripe for a reappraisal of approaches to the assessment of clinical competence in dentistry.
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Spurred by an initiative by the National Institute of Dental and Craniofacial Research in the USA, this article presents the need for a change in clinical dental research towards practice-based research. It outlines the shortcomings of past and present-day research in dentistry, with emphasis on the lack of clinical relevance of much of the research performed. The slow transfer of sound research findings to clinical practice is also a major problem. The article reviews some problems related to restorative dentistry and how they have adversely affected general dental practice. Practice-based research places emphasis on the problems experienced by clinicians in the routine care of patients. Clinicians should be linked together in research networks. The problems they face in dental practice and the clinical experience they have will form the basis for studies by the network. Experienced clinical researchers will provide guidance and statistical support for the studies initiated by the clinicians.
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Patients with bleeding disorders need close cooperation between their physician and their dental practitioner to receive safe, comprehensive dental care. When indicated, physicians must advise a compromised treatment plan to avoid deep injections or surgical procedures that may initiate a bleeding crisis in patients at risk. The conditions most commonly seen that require special consideration are long-term use of antithrombotic agents, platelet dysfunction caused by chronic renal failure, and congenital clotting factor deficiencies. Even these patients may undergo a high-risk procedure, such as periodontal surgery, with adequate precautions and preparation.
OBJECTIVE: The aim of this study was to investigate the effect of water on dental hard tissue ablation using Er:YAG laser as it relates to energy and pulse repetition rate, and determine the water flow rate that produces the most effective ablation at a given irradiation condition. BACKGROUND DATA: Er:YAG laser application leads to volumetric expansion and micro-explosions that result in hard tissue ablation. Ablation efficiency is improved when combined with fine water spray. MATERIALS AND METHODS: Extracted, healthy human molars were sectioned into two pieces and categorized into small groups related to water flow rate (1.69, 6.75, and 13.5 mL/min), pulse energy (250 and 400 mJ), and pulse repetition rate (5, 10, and 20 Hz). Within the combination of irradiation parameters, a laser beam was applied over enamel and dentin surfaces of the specimens, and the ablation amount was determined by differences in weight before and after irradiation. RESULTS: At a pulse energy of 250 mJ, the most effective ablation resulted from a water flow rate of 1.69 mL/min in both enamel and dentin. With 400 mJ/pulse, dentin removal was most effective at the water flow rate of 1.69 mL/min, whereas the efficiency of enamel ablation was the highest at 6.75 mL/min. Dental hard tissue ablated better as energy and pulse repetition rate increased. CONCLUSION: Effective ablation of dental hard tissue using Er:YAG laser requires that the appropriate water flow rate correspond properly to irradiation conditions. The results of this study suggest the following parameters; a water flow rate of 1.69 mL/min for enamel and dentin ablation at a pulse energy of 250 mJ and for dentin ablation at 400 mJ/pulse, and a water flow rate of 6.75 mL/min for enamel ablation at a pulse energy of 400 mJ, regardless of pulse repetition rate of 5, 10, and 20 Hz.