[Ammonium silver nitrate in infantile odontology; penetration and precipitation in dentine].
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OBJECTIVES: To determine the reasons for referral for dental general anaesthesia (DGA) in children in North Wales and to ascertain the level of repeat DGA. RESEARCH DESIGN: Retrospective study of the clinical records for a random sample of 10-year-old children who had a DGA before November 1998. SETTING: DGAs carried out at two centres within the Community Dental Service (CDS) in the former county of Clwyd, North Wales. METHOD: A random sample of children who had a DGA between April 1995 and November 1998 from whose records data was collected regarding the reason for referral and outcome. RESULTS: It was found that 26.6% of children had received an additional DGA, but the total of 203 additional episodes (including third and fourth DGAs) represents a true rate of 31.8%. The General Dental Service (GDS) referred more than double the numbers of children than the CDS but the referral rate per dentist was reversed with the GDS referring an average of 5.2 subjects and the CDS 11.9 subjects. Around half of all referrals did not include a medical history. CONCLUSIONS: The repeat DGA rate was cause for concern as was the quality of referrals.
In order to make a reliable diagnosis and offer appropriate treatment, it is important that the dentist is aware of the role played by psychosocial factors in the origin and persistence of dental problems and has the ability to recognise their importance in the patient's overall presentation. This paper is an attempt to improve dentist's awareness of psychosocial issues and recognition of possible psychological problems in general dental practice. It focuses on directions for the gathering of information on patients through careful assessment prior to dental examination, covering patients biological or physical history and present symptoms, their social background, their psychological history and mental functioning, and the observation of their behaviour and mood. It is argued that interpreting these types of information will enable the dentist to be better prepared for any pitfalls that may arise in the course of treatment.
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AIM: To examine two types of orthodontic separators, focusing on the separating effect and patients' perception of pain and discomfort. METHODS: The separators tested were spring-type and elastomeric separators. Thirty teenagers participated, and all were scheduled for treatment with a fixed orthodontic appliance. Two spring-type and two elastomeric separators were placed alternately in the left or the right quadrant. After a separation period of 5 days, the amount of separation was measured with a leaf gauge. Nine questionnaires with visual analogue scales and questions with fixed answers were used to register the patient perceptions. RESULTS: The mean separation was 0.3 mm for the spring-type and 0.4 mm for the elastomeric separators (P < .05). The springs were considered less painful than the elastomerics, but the difference was not statistically significant. For both separators, the pain was worst at day 2 and subsided almost completely by day 5. Due to pain, 14 of the 30 patients changed their food habits, and 13 took analgesics. CONCLUSIONS: The separation effect of the two separators was considered clinically equivalent and since pain of moderate intensity occurs during the separation period, analgesics and soft food can be recommended.
Patients complaining of pain in tooth bearing regions of the oral cavity may be suffering from a disorder unrelated to pulpal pathology. Unnecessary dental procedures may complicate the diagnosis and aggravate the underlying disorder. Referral of pain to the oral cavity and teeth may easily be explained by the extensive neurological connections of the trigeminal brain stem complex with other cranial nerves and input from the upper segment of the cervical spine. Accurate diagnosis of painful disorders can be a complex and time consuming process. The primary responsibility of the dentist in this scenario is to rule out the possibility of odontogenic pain.
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Clinical research was conducted to evaluate the extended-use safety and efficacy of Crest Whitestrips Supreme, a low-gel (100 mg on maxillary strip), 14% hydrogen-peroxide professional tooth-whitening system. The parallel-group study was randomized, double-blind, and placebo-controlled, and involved 39 healthy adults. During the treatment phase, subjects used the investigational products twice daily (for 30 minutes each) for 6 weeks (42 days). Safety and efficacy measurements were obtained at baseline and at the completion of each 3-week treatment period. Results showed that twice-daily use of Crest Whitestrips Supreme for 3 weeks resulted in a highly significant (P < .0001) improvement in tooth color, with a mean yellowness reduction (delta b*) of -3.3 and a mean brightness improvement (delta L*) of 2.4 relative to placebo. Color improvement continued with extended strip use over 6 weeks for all parameters (P < .0005). Relative to placebo at 6 weeks, color improvement was highly significant (P < .0001), with a mean delta b* of -4.1 and a mean delta L* of 3.2. Mild and transient tooth sensitivity and oral irritation were the most common adverse events. There was no evidence of any meaningful increase in adverse events with extended treatment through 6 weeks. Twice-daily use of Crest Whitestrips Supreme resulted in a highly significant improvement in tooth color after 3 weeks, with color improvement continuing over 6 weeks.
This clinical trial tested the efficacy and safety of a professional strip-based whitening system (Crest Whitestrips Supreme) using the manufacturer's recommended 3-week treatment regimen. These strips have a higher concentration, but a similar amount of hydrogen peroxide relative to Crest Professional Whitestrips, because the thickness of the gel on strips is reduced. Tooth whitening was measured using the value-oriented VITA Classic Shade Guide before and after treatment. Twenty-nine subjects were treated with either Crest Whitestrips Supreme or placebo strips that did not contain hydrogen peroxide. Participants in the experimental group achieved a mean lightening of nearly eight VITA shades relative to placebo, with minimal side effects.
A randomized clinical trial was conducted to compare the whitening effectiveness and tolerability of two daytime, professional, hydrogen-peroxide, vital-bleaching systems. Adults who had never bleached their teeth were randomly assigned to use either 14% hydrogen-peroxide whitening strips or a marketed 9.5% hydrogen-peroxide custom-tray-based system. Maxillary arch treatment was twice daily for 30 minutes for 9 to 21 days, depending on the labeled instructions for use. Whitening response was measured objectively as L*a*b* (which represent three-dimensional tooth color from light to dark, green to red, and blue to yellow, respectively) from digital images of the maxillary anterior teeth, while comparative at-home tolerability was assessed from bleaching tolerability severity days (BTSD) scores. A total of 31 participants aged 18 to 64 were evaluated. At the end of treatment, the adjusted mean (standard deviation [SD]) delta b* was -3.35 (0.37) for the strips and -1.67 (0.344) for the trays. Treatments differed significantly (P < .05) with respect to delta b*, as well as to delta L* and delta W* values at the end of treatment. Overall, at-home strip use was better tolerated, especially with respect to oral irritation. BTSD means (SD) were 0.09 (0.25) and 0.38 (0.49), with treatments differing significantly (P = .036), favoring the strips. This comparative research demonstrated that at the end of treatment, the 14% hydrogen-peroxide whitening strips resulted in a superior, twofold reduction in yellowness and better in-use tolerability compared to the 9.5% hydrogen-peroxide custom-tray system.
This paper provides a review of the literature concerning the etiology and manifestations of barodontalgia, as well as important clinical considerations for its management. Barodontalgia is characterized by exposure to a pressure gradient, such as that experienced by underwater divers, aviation personnel and air travellers. This form of dental pain is generally marked by a predisposing dental pathology such as acute or chronic periapical infection, caries, deep or failing restorations, residual dental cysts, sinusitis or a history of recent surgery. Studies indicate that severity of barodontalgia and the resulting deterioration of dental health correlates with duration of barometric stress. Restorative materials are also affected by pressure gradients. Resin is indicated as a luting agent of choice for cementing fixed prostheses in populations at risk for barodontalgia. Under the influence of pressure gradients, resin cements maintain original bond strength and demonstrate the least amount of microleakage compared with other cements. The key to avoiding barodontalgia is good oral health. Clinicians must pay close attention to areas of dentin exposure, caries, fractured cusps, the integrity of restorations and periapical pathology in those at risk. The Fédération dentaire internationale describes 4 classes of barodontalgia based on signs and symptoms and provides specific and valuable recommendations for therapeutic intervention.
The prevalence of caries in 5-year-old children living in fluoridated and non-fluoridated communities was investigated. Clinical examinations were completed on 342 children, of whom 247 had been continuously resident in their towns. Children living in fluoridated communities had significantly lower mean dmft and dmfs than children living in non-fluoridated communities. There was a marked social gradient in the non-fluoridated communities, which was not observed in the children from the fluoridated communities.
Pain control in endodontics is paramount to patient acceptance of this special area of dental care. Alleviating existing pain is the primary objective of root canal therapy. This paper focuses on the control of pulp and periradicular pain at initial presentation and subsequent to the first visit.
It should be apparent that the prompt and effective treatment of midtreatment flare-ups of all types is an essential and integral part of the overall endodontic treatment procedure. The expeditious management of these flare-ups will do much to enhance a positive attitude among patients toward endodontic treatment and to ensure the well-being and comfort of these patients.
Endodontic failure is a difficult diagnosis to confirm. Various other pathologic entities that must be ruled out by radiographs and tests have been discussed. Because of significant and, as yet, unresolved problems with surgical endodontic treatment, conservative retreatment should be given priority in treatment planning. Specialized techniques that can be used successfully to remove endodontic posts, gutta-percha silver cones, Thermafil, and paste filling materials from root canals have been discussed as well.