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At least 1,279 records · Page 71Linked to original sources
PubMed2000

Cementoenamel junction: microscopic analysis and external cervical resorption.

There is a lack of data regarding the shapes and distribution of the mineralized tissue that composes the cementoenamel junction. A sample of 198 permanent human teeth was analyzed by optical microscopy and scanning electron microscopy. Scanning electron microscopy showed three types of tissue interrelations: enamel overlapped by cementum; enamel and cementum edge-to-edge; and a gap, revealing a strip of exposed dentin. Using optical microscopy, a fourth type of cementoenamel junction was observed: cementum overlapped by enamel. The distribution of the hard tissues found at the cementoenamel junction is unpredictable and irregular both for any tooth type (e.g. on cuspids) and on any one individual tooth. Based on these results and on analysis of the mechanisms involved in cervical root resorption, it is possible to consider the cervical region as prone to external resorption.

Dental Cementum↗
PubMed1993

Rehabilitation of maxillofacial trauma patients with dental implants.

Maxillary and mandibular traumatic injuries are inevitable in our society. Dental implants can be considered for the replacement of teeth lost as a result of trauma, even in complicated cases where associated injuries, such as jaw fractures and bone loss, have occurred. Reimbursement for dental services by insurance companies in the case of traumatic injuries to the teeth and supporting structures is discussed.

Adolescent↗
PubMed1996

Bone augmentation and biopsy: clinical report.

A mixture of demineralized freeze-dried cortical bone and beta-tricalcium phosphate covered by titanium-reinforced expanded polytetrafluoroethylene membranes was used for bone augmentation in an accident case in which a young female patient suffered anterior maxillary damage. Hydroxyapatite-coated implants were placed in the newly formed bone-like material before prosthodontic reconstruction. A biopsy suggests the bone-like material was essentially normal lamellar and woven bone.

Accidents, Traffic↗
PubMedDate not supplied

Decision making for the patient who presents with acute dental pain.

Patients who require dental emergency care for pain or trauma may not be able to see a dental practitioner for treatment. The patients often seek care in alternative medical facilities when the symptoms are too severe to be managed by over-the-counter medications. Nurses, physicians, and allied medical staff may be required to triage these patients and provide palliative treatment until the patient is able to seek definitive dental treatment. By using criteria to assess the etiology of the dental pain and implementing possible alternative treatments, these patients can receive palliative care until dental treatment becomes accessible. With the potential for development of resistant forms of microorganisms, the indiscriminate use of antibiotics for dental pain is to be avoided. Occasionally, dental patients presenting to medical settings exhibit symptoms and signs of dental-related problems that are potentially life threatening. Identification of signs of impending life-threatening complications is of paramount importance, since prompt treatment will significantly affect the prognosis.

Acute Disease↗
PubMed2002

A dental risk management protocol for electroconvulsive therapy.

This article describes the results of an evaluation of a system to use trained junior psychiatric doctors to perform the pre-ECT oral assessment. All junior doctors were given a 1-hour training session in making oral assessments, and their ability to diagnose was tested by dental follow-up visits to patients they had assessed. Seventy-one patients were seen by both doctor and dentist, and the sensitivity for doctors ranged between 92% for the presence of dentures or removable bridges to 8% for the presence of teeth vulnerable to fracture. Where the doctors made a positive diagnosis, these were not always correct; the positive predictive value ranging from 92% for dentures or removable bridges to 25% for teeth vulnerable to fracture. It is concluded that the use of trained doctors is better than no assessment but falls short of that provided by a dentist with experience of psychiatric patients undergoing ECT.

Adult↗
PubMed2005

Effects of pre-emptive morphine, ibuprofen or local anesthetic on fos expression in the spinal trigeminal nucleus following tooth pulp exposure in the rat.

In the present study, we used Fos expression as an index of nociceptive input to the spinal trigeminal nucleus after exposure of the coronal pulp tissue of maxillary right first molars and examined the effects of pretreatment with an opioid, a nonsteroidal anti-inflammatory drug or a local anesthetic before pulp exposure. Exposure of the tooth pulp produced a significant increase in Fos-like immunoreactivity in the superficial laminae of subnucleus caudalis; pretreatment with a control infiltration injection of saline directly above the maxillary molar 30 min before pulp exposure had no effect on Fos expression. Pretreatment with morphine 30 min before pulp exposure dose-dependently (2.5, 5, and 10 mg/kg subcutaneously) reduced Fos expression in subnucleus caudalis whereas pretreatment with ibuprofen (10-100 mg/kg subcutaneously) did not significantly affect Fos expression. Local anesthetic pretreatment was effective in reducing Fos expression only for the long acting bupivacaine; lidocaine without and with epinephrine (1:100,000) failed to significantly affect Fos expression. These results suggest that pre-emptive opioid treatment can decrease postoperative central nervous system changes associated with tooth pulp injury, and therefore, may decrease postoperative pain. Given the effects of local anesthetic on Fos expression, a combination of long acting local anesthetic with pre-emptive opioid would likely be most efficacious in decreasing postoperative dental pain.

Analgesics, Opioid↗
PubMed2004

To distract or not to distract: an algorithm for airway management in isolated Pierre Robin sequence.

Approaches advocated for treatment of airway obstruction among neonates with Pierre Robin sequence include positioning, tongue-lip adhesion, mandibular distraction, and tracheostomy, with no established guidelines regarding which modality is appropriate for a specific patient. This report proposes an algorithm for the management of neonatal upper airway obstruction among patients with isolated Pierre Robin sequence. Data for 21 patients with isolated Pierre Robin sequence who were treated by one surgeon during a 9-year period were reviewed. Eighteen patients presented during the first 1 week of life and three patients presented late, between 12 and 33 months of age. Follow-up periods ranged from 9 to 70 months (median, 33 months). Successful airway management was achieved with positioning alone for 10 patients, with tongue-lip adhesion for seven of nine patients, with tracheostomy for two patients, and with mandibular distraction for three patients. Changes in the maxillary-mandibular discrepancy were significant with natural mandibular growth during the first 1 year of life (p < 0.0001). Oromotor studies performed 3 months or more after tongue-lip adhesion reversal (n = 9) demonstrated no appreciable deficits in tongue function, relative to other children with cleft lips/palates. A multidisciplinary team should evaluate all patients with isolated Pierre Robin sequence, to fully assess the maxillary-mandibular relationship, anatomically define the site of airway obstruction, and identify feeding difficulties. Patients should be evaluated for episodes of desaturation occurring spontaneously, during feeding, or during sleeping. Patients with desaturation should be further evaluated with double endoscopy (nasoendoscopy and bronchoscopy). If the airway obstruction is localized to the tongue base alone and cannot be controlled with positioning, then tongue-lip adhesion is the initial treatment of choice, because such patients demonstrate significant mandibular growth during the first 1 year of life. Mandibular distraction among neonates is reserved for failures of tongue-lip adhesion in which isolated tongue-base airway obstruction is documented. Neither of the patients who experienced failure of tongue-lip adhesion in this series would have been a candidate for distraction with the algorithm presented. Avoiding routine neonatal distraction serves to avoid facial scarring, nerve and tooth bud injury, and potential disturbances of intrinsic mandibular growth. Patients with persistent respiratory difficulties beyond age 9 months require reevaluation for multiple sites of airway obstruction. Mandibular distraction may be one of several modalities required to avoid tracheostomy for such patients.

Algorithms↗
PubMed1997

The effect of a toothguard on the difficulty of intubation.

Dental damage is the most common reason for complaints against anaesthetists. The purpose of this study was to investigate the common belief that the use of a toothguard at the time of intubation causes intubation to be more difficult. We studied 80 patients, half of whom were intubated with a toothguard in situ and the other half intubated without a toothguard. The time taken from mouth opening to successful passage of the tracheal tube through the vocal cords was measured. In the toothguard group, the recorded time also included the time taken to insert the toothguard. The median time to intubation in the group with a toothguard was 24 s and the median time to intubation in the group without a toothguard was 17 s. The difference of 7 s in the time to intubation was statistically significant (p = 0.0003). As the recorded times also included the time taken to insert the toothguard, we do not regard this result to be clinically significant and believe that anaesthetists should think carefully before disregarding this simple protective device.

Adolescent↗
PubMed2004

Consent for tonsillectomy.

Rulings in recent negligence cases reveal a shift towards what the 'reasonable patient' would expect in deciding the risks doctors must disclose to patients. This survey aimed to investigate whether the 'reasonable patient' and 'responsible body of medical opinion' agree about which risks should be discussed regarding tonsillectomy. Using questionnaires, surgeons were asked which of the 10 complications they routinely discussed and patients were asked how seriously they regarded these complications. The results were compared with the Test of Proportions. Most surgeons routinely mentioned otalgia, odynophagia, throat infection and re-operation. Most patients regarded potentially fatal bleeding, pneumonia and blood transfusion as very serious but only the minority of surgeons mentioned these (P < 0.001). When obtaining consent for tonsillectomy, surgeons do not routinely mention all the risks that the 'reasonable patient' would expect. The 'reasonable patient' would expect that re-operation, transfusion, pneumonia and fatal blood loss are discussed.

Blood Transfusion↗
PubMed1989

An investigation of possible iatrogenic damage caused by metal rubber dam clamps.

Rubber dam may be held in place over a tooth by metal clamps. It has been shown that a mismatch of contact between the clamp gripping edge and the tooth surface may be reduced to a point contact, thereby concentrating the gripping force generated by the bow of the clamp. Experiments were conducted to measure the force. Clinically realistic loading of the tooth surface by sections of the gripping edge of clamps was carried out using special apparatus. Examination by scanning electron microscopy showed that iatrogenic damage to the tooth could occur. Therefore a plea is made for clamps to be redesigned to reduce any harm.

Dental Instruments↗
PubMed2006

Cemental tear: a case report.

AIM: To report a case of a cemental tear. SUMMARY: A case is reported of a patient with a history of trauma, root canal treatment and retreatment procedures to eliminate recurring sinus tracts. An exploratory surgery, extraction, and biopsy resulted in a diagnosis of cemental tear. KEY LEARNING POINTS: * The detachment of a fragment of cementum is described as a cemental tear. * Cemental tears have been reported in the periodontal literature associated with localized, rapid periodontal breakdown. Common causative factors are aging and traumatic occlusion but the exact aetiology is unknown. * Trauma may be considered as a potential aetiologic factor for cemental tears in addition to occlusal traumatism and aging.

Adult↗
PubMed1995

Dental caries, tooth trauma, malocclusion, fluoride usage, toothbrushing and dietary habits in 4-year-old Swedish children: changes between 1967 and 1992.

The dental health of 4-year-old children in the city of Umeå, northern Sweden, has been followed in cross-sectional studies conducted in 1967, 1971, 1976, 1980, 1987 and 1992. Similar methods and criteria were used. Dental caries and background factors (fluoride usage, toothbrushing frequency and diet) were recorded. In 1971, 1987 and 1992 signs of tooth trauma and presence of malocclusion were also recorded, the latter also in 1976. The present paper summarizes the results of these studies. Between 1967 and 1992 the mean dmfs values declined from 7-8 to 1-8. The decline was greatest between 1967 and 1980 and then levelled off. Toothbrushing frequency was similar over the years, but parental help with brushing was more common in the more recent studies. The use of fluoride toothpaste increased. About 30% of the children had experienced tooth trauma. A unilateral crossbite was recorded in 18% and 16% of the children in 1971 and 1992, respectively, and an anterior open bite in about 35% and 41%, respectively; both types of malocclusion were related to a dummy- or finger-sucking habit.

Child, Preschool↗
PubMed1996

An audit of anterior periapical radiographs taken in a paediatric dentistry unit.

The aim of this study was to audit the use of periapical radiographs taken during the endodontic treatment of traumatized incisor teeth in a Paediatric Dentistry Unit. Fifty consecutive radiographs and their accompanying written records were evaluated, using methods which were developed and applied by ten staff and postgraduate students working in the Unit. Less than half of the films and their accompanying records were considered to be completely satisfactory and the performance of permanent staff was no better than that of junior staff and postgraduate students. The audit suggested methods for improving the quality of this service, which were subsequently implemented.

Child↗
PubMed2006

The frequency of repeat general anaesthesia for teeth extractions in children.

AIM: The purpose of this study was to determine the frequency of repeat extractions under general anaesthesia (GA) in children. METHODS: The dental hospital records of patients attending for outpatient GA extractions at Liverpool University Dental Hospital, Liverpool, UK, between January and March 2003 were examined retrospectively. A data collection form was used to record the relevant information. RESULTS: A total of 278 patients with a mean age of 6.5 years (SD = 2.2 years) were seen for GA extractions. Of those, 33 patients (11.9%) with a mean age of 4.9 years (SD = 2 years) at the time of their initial GA had had a previous or would undergo a subsequent episode of GA extraction. The mean interval between repeat GA was 2.3 years (SD = 1.6 years). Fifteen cases (45.5%) had the repeat GA within 2 years. Radiographs were available as part of the assessment process for 84 (34.3%) of the 245 patients who had had a single episode of GA. However, of the 33 patients who had had a repeat GA, only seven (21.2%) had radiographs available at the time of the initial GA. Regarding the number of teeth extracted, a significant difference (P < 0.01) was found between the number of teeth extracted in patients who had had a single GA (mean = 4.6, SD = 2.5), compared with those extracted at the initial GA for the repeat GA group (mean = 3.2, SD = 2). CONCLUSION: The frequency of repeat GA is relatively low, but there is a need for appropriate treatment planning incorporating the use of radiographs to reduce this even further.

Adolescent↗
PubMed1988

The effect of contact area morphology on operative dental procedures.

Measurements of the contact and embrasure areas of adjacent extracted teeth set in plaster blocks were made before groups of dentists undertook preparations on them. The prepared and adjacent teeth were examined and the findings related back to these measurements. Damage to the adjacent teeth was a common finding with both mesial-occlusal-distal (MOD) and complete crown preparations. There was some evidence that easier access to the contact area reduced the frequency of damage to teeth adjacent to MOD preparations. The taper of complete crown preparations did not conform to commonly recommended designs. This investigation highlights the need for greater consideration of approximal tooth surfaces when undertaking preparations and questions the practicality of achieving traditional features of complete crown preparation design. In teaching, greater emphasis should be placed on clinical reality rather than on theoretical, but unachievable ideals.

Crowns↗