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PubMed2003

Tooth brushing and utilization of dental services in Fiji (1998).

Utilization of services is considered the presence or absence of care received. The most common measure of utilization is the annual number of dental visits per person. This study aims to determine oral health practices, which were a measure of their oral hygiene status and the use of health care facilities. It also aims to investigate the major problems that exist within the health care system in 1998, which may explain the lack of use of dental services. Fijians and Indo-Fijians were two ethnic groups in the sample, selected by stratified multi-stage cluster sampling. Only two age categories, 15-19 and 35-44 year-olds were selected being the index age for World Health Organization in Oral Health Surveys. A total of 1,000 questionaires were distributed and the completed questionnaires (n = 619) were collected immediately. Thirty one percent of the respondents indicated that they learnt to care for their teeth from dental personnel. Of the individuals who brushed their teeth twice a day, 41% visited the dentist within the last 12 months. Majority of the individuals (65%) who brushed their teeth twice or more daily indicated that they needed dental treatment. Individuals who visited the dentist within the last 12 months reported having a tooth extracted (53%), check-up (29%), filling (8.9%), polishing of teeth (3.7%), gum problem (3.2%) and false teeth (1.8%). Individuals who brushed twice daily did not visit the dentist within the last 12 months because nothing was wrong (63.2%), too busy (9%) and afraid of the dentist (7%). More than 80% of the respondents were satisfied with the current services, but indicated improvement on the waiting time (31.2%), availability of more treatment options in dental clinics (27.5%), dental fees (15.4%), improvement on the facilities for dental care (10.1%), a customer-friendly dental personnel (9.4%) and considerations for infection control (6.4%).

Adolescent↗
PubMed1997

Cultural alteration of human teeth in the Mariana Islands.

Evidence of cultural dental modification in a precontact (pre-1521) skeletal sample from the Academy of Our Lady of Guam gymnasium site in Agana, Guam, is documented. Two of the four individuals recovered at the Academy Gym site exhibit modification of the maxillary teeth. One individual displays vertical incising of a single tooth, and the other exhibits horizontal abrading of the anterior teeth which may be a purposeful or an incidental alteration. Although deliberate alteration of the dentition, including tooth extraction, notching, filing, and drilling, has been documented in human groups worldwide, little has been written about these cultural practices in the Mariana Islands. Examination of the available literature on precontact human remains from the region reveals at least three patterns of dental incising and similar cases of dental abrasion. While the origins of these practices are not known, the presence and style of these cultural alterations may be sex-specific, cosmetic in nature, or an indication of status in a ranked society. Alternatively, they may signify membership in a particular group or lineage, or mark a rite of passage. Because the comparative samples are limited in number and small, and the provenience of many of the skeletons is obscure, temporal variation cannot be ruled out.

Cosmetic Techniques↗
PubMed1997

Reliability of a self-reported health questionnaire in a periodontal disease study.

This study assesses the reliability of a self-reported health questionnaire completed by 413 subjects aged 25-74 yr in the Erie County Periodontal Disease (ECPD) Study. Specific questions on general and oral health conditions were completed by each subject during a first visit and at a follow-up examination 2 yr later, and the two compared. Results showed that the overall measure of agreement between the two visits is substantial (average kappa, kappa = 0.80). Variation by gender and age were minimal. Questions regarding allergy to medications, oral treatment, reason for tooth extraction, health symptoms and history of systemic diseases exhibited high levels of agreement (kappa ranged from 0.71-0.90). Information on vitamin and mineral intake yielded kappa = 0.63. Oral conditions scored the lowest but were still acceptable (kappa = 0.57). These findings indicate that there were no significant discrepancies in self-reported responses to the health questionnaire used in the ECPD Study. Although the information provided by the subject may not be as accurate as compared to laboratory testing, it is nevertheless a reliable source of information which can be utilized cost-effectively in research studies.

Adult↗
PubMed2005

Haemostatic management of intraoral bleeding in patients with von Willebrand disease.

OBJECTIVES: To develop plans for the haemostatic management of intraoral bleeding in patients with von Willebrand disease (VWD). SUBJECTS AND METHODS: Thirty-seven episodes of haemostatic management of intraoral bleeding in 19 VWD patients were analysed retrospectively based on the medical records. RESULTS AND CONCLUSIONS: When performing tooth extractions in patients with type 1 or 2A VWD [responsive to 1-deamino-8-D-arginine-vasopressin (DDAVP)], 0.35-0.4 microg kg(-1) of DDAVP should be administered intravenously at three times. In patients with type 2A VWD (unresponsive to DDAVP) or patients with type 2B or 2N VWD, 50-90 U [as ristocetin cofactor (VWF:RCof)] kg(-1) of a factor VIII concentrate containing von Willebrand factor (FVIII/VWF concentrate) should be administered twice in routine extractions, and four to six times in surgical extractions. Gingival bleeding related to primary teeth can be mostly managed by pressure haemostasis alone. However, when treating gingival bleeding caused by marginal periodontitis, it is often necessary to administer 0.4 microg kg(-1) of DDAVP or 40-70 U (as VWF:RCof) kg(-1) of a FVIII/VWF concentrate. As local haemostasis is difficult to achieve in bleeding from the tongue or labial or mandibular haematoma, it is necessary to administer 0.4 microg kg(-1) of DDAVP or 60-80 U (as VWF:RCof) kg(-1) of a FVIII/VWF concentrate. In addition, oral administration of 20 mg kg(-1) day(-1) of tranexamic acid should be combined with the regimens described above.

Adolescent↗
PubMed2004

Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unit.

OBJECTIVES: To determine which variables were best related to the overall morbidity of a child undergoing dental general anaesthetic (GA) and then to use these variables to determine those factors that might influence the extent and severity of morbidity experienced by healthy children following dental GA. SAMPLE AND METHODS: Data were collected on anxiety, pain and morbidity, GA procedure and dental procedure from 121 children attending a day stay GA unit for dental treatment. Patients were interviewed preoperatively, postoperatively before discharge then four further times over the next 148 h. Data were analysed using multivariate regression. RESULTS: Thirty-one per cent of subjects had restorative work, 60% had at least one tooth extracted, 54% had a surgical procedure. Use of local analgesia reduced postoperative pain whilst an increase in the number of surgical procedures increased it. Increase in anaesthetic time was related to increased odds of feeling sleepy and nauseous, females were more likely to complain of sleepiness or weakness. Feelings of dizziness were increased if the patient was given local analgesia during the procedure. CONCLUSIONS: Pain following dental GA was the most prevalent and long lasting symptom of postoperative morbidity in this study. Reductions in operating time and improvement in pain control have the potential to reduce reported morbidity following dental GA.

Adolescent↗
PubMedDate not supplied

Combined mucormycosis and Aspergillosis of the rhinocerebral region.

BACKGROUND: Opportunistic fungal infections are rare, life-threatening conditions and are a major cause of morbidity and mortality in immunocompromised hosts. Our experience in the management of a case of combined mucormycosis and aspergillosis of the rhinocerebral region is presented. PATIENTS AND METHODS: The infection developed a few weeks after tooth extraction, massively involving facial structures. After diagnosis, the patient underwent prolonged combined systemic antifungal treatment. Once the local and general conditions had stabilized, an extensive surgical debridement was performed, followed by reconstruction with a pedicled myocutaneous flap. RESULTS: This approach was curative with patient survival after 16 months. CONCLUSION: Early diagnosis, early anti-fungal treatment and early stabilization of the patients' general condition are fundamental for patient survival. Surgery is necessary for fungal eradication, but must be performed according to the above conditions. Pedicled muscle flaps are considered the first reconstruction choice because of their excellent blood perfusion and resistance to fungal invasion.

Amphotericin B↗
PubMed2003

Actinomycosis abscess of the thyroid gland.

OBJECTIVES: To present an unusual case of actinomycosis abscess of the thyroid gland as well as review the history, etiology, pathogenicity and treatment of actinomycosis infections of the head and neck. STUDY DESIGN: Case study. METHODS: A report of a 39 year-old female status post tooth extraction that developed an actinomycosis abscess of the thyroid. RESULTS: After a thyroid actinomycosis abscess was suggested by physical exam, ultrasound, CT scan and needle aspiration, an otolaryngology consult was obtained. The patient successfully was managed with thyroidectomy and intravenous ceftriaxone. CONCLUSIONS: Although Actinomycosis soft tissue infections of the head and neck are relatively uncommon, the head and neck surgeon must include it in the differential diagnosis when clinical presentation raises suspicion. Early biopsy is necessary for appropriate identification of the organism with the appearance of sulfur granules lending a clue to the diagnosis. Debridement and/or excision are often necessary for antibiotics to be used successfully. Antimicrobial therapy should be used for six to twelve months to completely eradicate the disease and prevent recurrence.

Abscess↗
PubMed1992

Increase in c-fos-like immunoreactivity in the trigeminal nucleus complex after dental treatment.

An immunohistochemical study was made of the temporal changes in the expression of the c-fos oncogene protein in the spinal trigeminal nucleus complex (STNC) after three different types of dental injury. One hour after tooth extraction or pulp exposure, c-fos neurons appeared in the ipsilateral subnucleus caudalis, but there were very few c-fos neurons in the ipsilateral subnuclei oralis and interpolaris, and in the trigeminal main sensory nucleus and contralateral STNC. The great number of c-fos neurons was found 2-4 hours after injury, levels decreased by 8 hours after injury. Twenty-four hours after injury, the number of these neurons in subnucleus caudalis became very small. Shallow cavity preparation, however, did not induce an increase in the number of c-fos neurons at any selected postoperative time in STNC. These results indicate that c-fos neurons appear mainly in subnucleus caudalis very soon after severe dental injury.

Animals↗
PubMedDate not supplied

[Rhino-orbital zygomycosis].

Zygomycosis is rare but highly invasive fungal infection, with high mortality rate. A 67 years old diabetic man was presented with rhino-ocular form of the disease. Fungal elements invaded the skin and subutaneous facial tissue, with involvement of the nose, paranasal sinuses and orbit. The portal of entry of fungus was through paranasal sinuses, after the tooth extraction. Various clinical manifestations were presented: headache, facial swelling, tenderness over the involved sinuses, unilateral orbital cellulitis with proptosis, facial and orbital pain, black nasal discharge, decreased visual acuity, blindness. Patient was treated surgically and by liposomal amphotericin B. He underwent maxillectomy, ethmoidectomy and sphenoidectomy and orbital exenteration because of the dissemination of the disease into the orbit. The specific diagnosis of the infection was established upon the microscopic demonstration of casual agent in the debridement tissue. Early diagnosis was important in this highly fatal disease. Aggressive surgical debridement, therapy with amphotericin B and correction of underlying metabolic acidosis must be performed. The successful medical therapy in this patient suggests that lipid formulation of amphotericin B should be given, because this antifungal agent performed the best control of the infection with the minimal adverse effects.

Aged↗
PubMed2005

Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial.

BACKGROUND: The aim of this study was to establish the efficacy of two different preparation packages, a paper-based cartoon and an interactive computer, at facilitating coping behavior in children undergoing dental general anesthetic (DGA) tooth extraction. METHOD: A total of 198 children were allocated randomly to computer, cartoon or control groups. A Visual Analog Scale (VAS) and Modified Child Dental Anxiety Scale (MCDAS) were used to compare preoperative anxiety levels between the three study groups. Blinded observers then scored behavior at both anesthesia induction and upon recovery using a VAS for each (0 = coped/no distress and 10 = no coping/high distress). RESULTS: The children's median age was 5 (range 3-10) years, 57% were boys, a median of seven teeth were extracted (range 1-20). Preoperative anxiety was similar for all preparation groups; with 24% of all children categorized 'phobic' using MCDAS. The median induction (coping) VAS level for both the computer and the cartoon groups was '1' (range 0-10), compared with the control group level of '3' (range 0-10). The median recovery (coping) VAS levels were: computer group: 0 (range 0-10), cartoon group: 4 (range 0-10) and control group: 2.5 (range 0-10). The Mann-Whitney U-test showed that the computer group coped significantly better than the control group at induction (P = 0.014) and significantly better than the cartoon group upon recovery (P = 0.016). The statistical power for detecting differences between groups (computer/cartoon versus control) was calculated to be 90%, based on pilot study data. CONCLUSIONS: The computer preparation package facilitated coping behavior in children undergoing DGA induction.

Adaptation, Psychological↗
PubMed1993

Perceived need and use of oral health services among adolescents and adults in Tanzania.

The perceived need and use of oral health services among adolescents and adults in Tanzania were studied. One region from each of the country's five zones was chosen at random. Final sample selection (n = 1061) was done in the main towns of the selected regions. Participants were interviewed using a structured questionnaire which dealt with perceived need for dental treatment and use of oral health services and several demographic variables. Frequency tables were computed and analyzed. Odds ratios were calculated based on 2 x 2 tables and logistic regression models. The majority, 82% (95% CI: 79-85%) had sought treatment due to pain or for tooth extraction. Perceived need, dissatisfaction with own oral health status and use of oral health services were slightly more frequent among women. Bleeding gums had no explanatory value on the dependent variables. The strongest explanatory variable in a logistic regression model for perceived need and dissatisfaction with own oral health status was previous dental treatment with an estimated odds ratio of 6.4 (95% CI: 4.7-8.7) and 7.2 (95% CI: 5.3-9.9), respectively. People living nearest a treatment facility tended to use the services more [odds ratio 1.3 (95% CI: 0.8-2.1)]. A very strong relation between previous dental problems and use of oral health services was found, namely an odds ratio of 68.8 (95% CI: 39.0-121.4). The findings in the study may be useful in the attempts to implement Tanzania's National Plan for Oral Health.

Adolescent↗
PubMed2002

Response of wild subantarctic fur seal (Arctocephalus tropicalis) females to ketamine and tiletamine-zolazepam anesthesia.

This study is the first to compare the anesthetic effects of two cyclohexamines on free-ranging subantarctic fur seal (Arctocephalus tropicalis) females. From April to July 1999, 107 females were immobilized for tooth extraction and blood sampling, using either ketamine (Ketalar, n = 58) alone or tiletamine-zolazepam (Zoletil 100, n = 49) mixture. Animals were injected intramuscularly at mean doses of 2.1 mg/kg for ketamine and 1.1 mg/kg for tiletamine-zolazepam mixture. Individual response to both drugs was highly variable. The dosage required to achieve a satisfactory level of anesthesia was smaller for subantarctic fur seals than for most other species of seals and was less for animals in better body condition. Few side effects were observed during the trials, aside from mild tremors caused by ketamine, and respiratory depression or prolonged apnea caused by tiletamine-zolazepam. We recommend use of ketamine, especially by those with little experience in anesthesia of fur seals. However, precautionary measures should be taken, such as using low doses for animals in good body condition and being prepared for anesthetic emergencies to avoid any casualties.

Anesthetics, Combined↗
PubMedDate not supplied

Bisphosphonates and oral cavity avascular bone necrosis: a review of twelve cases.

BACKGROUND: Intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. PATIENTS AND METHODS: The data for twelve patients, referred to either an oral and maxillofacial surgeon or to an oral medicine specialist for the management of clinically apparent chronic oral osteonecrosis of unknown etiology, were reviewed. All had received cancer-related therapy simultaneously with bisphosphonate management. RESULTS: The typical presenting symptoms were pain and exposed bone at the site of a previous tooth extraction. In most patients, the lesions initially occurred after dental extraction or other odontostomatological procedures, while five had a spontaneous event. Biopsy of the involved area showed the presence of necrotic lacunae, with infiltration of lymphocytes and histiocytes. In nine cases, there was histological or cytological diagnosis of suspicious osteomyelitis. No correlation was observed between the intraoral lesions and myelosuppression secondary to antineoplastic therapy. CONCLUSION: Based on the patients' respective histories, clinical presentations and responses to surgical and antibiotic treatments, it appears that the pathogenesis of this osteonecrotic process is most consistent with localized vascular insufficiency. In our opinion, the mechanism by which bisphosphonates compromise bone vascularity may be related to their effect on the osteoclasts. The potent bisphosphonate-mediated inhibition of osteoclast function serves to decrease bone resorption and inhibit normal bone turnover remodeling, resulting in microdamage accumulation and a reduction in some mechanical properties of the bone.

Aged↗
PubMed2003

Osteoconductive and hemostatic properties of apatite formed on/in agarose gel as a bone-grafting material.

The biologic behavior of hydroxyapatite formed on/in agarose (HA/agarose) gels with the use of a novel alternate soaking process was compared with commercially available Bone Ject (True-Bone ceramic-collagen combined bone-graft material, Koken, Japan) as a filler for the tooth-extraction sockets of six adult monkeys (Macasa fascicularis). After the monkeys' first premolars were extracted, the defects created were replaced with one of the following materials: (a). HA/agarose created by 12 soaking cycles, (b). HA/agarose created by 9 soaking cycles, (c). Bone Ject, and (d). no material implantation (control). The time of hemostasis in each extraction site was estimated, and the samples were then studied histologically. In the controls, the time of hemostasis was about 5 min. The Bone Ject particles were easily washed out by bleeding, and the time of hemostasis was about 15 min. The HA/agarose gel was densely packed into the bony defect. The hemorrhage from the defects stopped within a few seconds after graft placement. This hemostasis was most likely related to the compactibility and adhesiveness of the material. After 12 weeks of implantation, free Bone Ject particles surrounded by inflammatory cells were observed. The bony defect filled with the HA/agarose gels was completely absorbed and replaced by newly formed bone possessing bone marrow. There was no difference in the biologic behavior of HA/agarose gels created by 9 versus 12 soaking cycles. The present study suggests that HA/agarose gels may play an important role as an alternative biodegradable bone-graft material for autogenous bone in humans.

Animals↗
PubMed1990

An evaluation of the closed mouth mandibular block technique.

This randomised double-blind study compared the efficacy of the closed-mouth and the conventional mandibular block injection techniques in 200 patients requiring anaesthesia for tooth extractions. Results showed the success rate of inferior alveolar nerve anaesthesia with a single injection to be 97% in the conventional group, and 79% in the closed-mouth group. Within 5 min after the injection, 87% of the conventional group as compared with 55% of the closed-mouth group had lip numbness. The conventional and closed-mouth techniques, respectively, yielded 22% and 2% positive aspirations. Long buccal nerve anaesthesia during the closed-mouth injection was achieved in 71% of cases. Both techniques produced similar pain responses, as well as changes in blood pressure and pulse rate. The closed-mouth injection technique produced a greater variety of unexpected symptoms than the conventional. It was concluded that the conventional technique was more effective in blocking the inferior alveolar nerve, and was also faster in producing anaesthesia, but yielded more positive aspirations than the closed-mouth technique.

Adolescent↗
PubMed2001

Geriatric oral health issues in the United Kingdom.

The current status of geriatric oral health in the United Kingdom is influenced by an historical pattern of care prevalent during the early years of the National Health Service in 1948, when inexpensive oral health care became available to all. At that time, tooth extraction was perceived as an acceptable, and among some people a preferred, approach to oral care. This has left a legacy of edentulism among senior citizens, which affects both oral and general health, in addition to an attitude that places oral health as a low priority. This legacy is now beginning to unwind as cohorts of adults, who have benefited from low-cost dental care for the majority of their lives, are entering their senior years. Many of these young-old retain their natural teeth and have more positive attitudes towards oral health. This paper discusses the impact of this history as well the effect of income on access to care, the influence of the ageing process on adequate oral hygiene and the availability of dentists trained to treat both dentate and edentulous geriatric patients. A brief outlook for the future is also provided.

Adult↗
PubMed2002

Oral health behaviour of schoolchildren and parents in Jordan.

OBJECTIVES: The objectives of the study were: (i) to assess the level of dental knowledge and attitudes towards child dental care among parents in Jordan, (ii) to analyse the oral health care habits of schoolchildren and parents, and (iii) to evaluate the oral hygiene habits and use of professional dental services of children in relation to socio-demographic conditions. DESIGN: Cross-sectional, self-administered questionnaires for parents. SAMPLE AND METHODS: National representative sample of 6-16-year-olds living in urban areas (n = 1556, children and parents, response rate 92%, 48.7% boys, 51.3% girls). RESULTS: In all, 80% of the parents knew about the harmful effect of sugar and 79% thought that poor oral hygiene may induce dental caries. In addition to proper oral hygiene (79%) and restriction of sugar/sweets (42%), 36% of the parents emphasized regular dental visits for the prevention of dental disease in children. However, most children saw a dentist for symptomatic reasons only (86%), while 11% attended for dental check-ups. At their last visit to the dentist, 49% of the children had tooth extraction and only 8% had preventive services (fissure sealing). Toothbrushing at least twice a day was reported for 31% of the children; 14% of children aged 6-9 years had assistance from adults in brushing. Dental care habits of children were highly affected by dental visiting habits of parents, and variations by level of education of parents were also found. CONCLUSIONS: The discrepancy between dental knowledge and attitudes of parents and oral health care practices indicate the need for oral health education. School-based oral health promotion programmes should be established in Jordan to influence the oral health behaviour of children and parents and to avoid further deterioration in their oral health.

Adolescent↗
PubMed1989

Repressive coping style and anxiety in stressful dental surgery.

Elevated state-anxiety prior to oral surgery is common and is associated with increased post-operative pain. This paper presents a psychological model of predicting elevated anxiety prior to dental surgery. Elevated anxiety and intraoperative stress can be predicted by measuring trait-anxiety. However, prediction may be improved by using a situationally specific measure of trait-anxiety, and by taking the patient's coping style into account. Thirty-nine patients undergoing wisdom-tooth extraction took part in the study. The Corah Dental Anxiety Scale was a better predictor of pre-operative anxiety than the STAI trait-anxiety scale. Coping style was measured by means of the Marlowe-Crowne Social Desirability Scale in conjunction with scores on trait-anxiety to define three coping style groups: sensitizers (high-anxious), truly low-anxious, and repressors who verbally deny anxiety. Two oral surgeons rated patient intra-operative state on 100 mm visual analogue scales. These ratings indicate that 'repressors' exhibit significantly more stress responses than the truly low-anxious group, in spite of similar (low) trait-anxiety scores. It is concluded that a situationally specific measure of trait-anxiety is the most appropriate predictor of differential state-anxiety elevations prior to oral surgery. Repressive coping style may be a confounding factor, in terms of predicting elevated anxiety, since some people verbally deny being anxious but express it behaviourally.

Adolescent↗