Iowa Board of Dental Examiners, September, 2004, Vol 2, no. 2

Newsletter produced by the Iowa Dental Board.

Iowa Board of Dental Examiners, April 2005, Issue 6

Newsletter produced by the Iowa Dental Board.

Iowa Board of Dental Examiners, January 2006, Issue 7

Newsletter produced by the Iowa Dental Board.

Iowa Board of Dental Examiners, July 8

Newsletter produced by the Iowa Dental Board.

Musicoterapia creativa en pacientes con càncer: un método para disminuir la ansiedad y el estrés

Se explica cómo un grupo de pacientes con cáncer aprendieron a usar la música para lograr estados de mayor tranquilidad emocional, rebajando su ansiedad y estres producidos por la incertidumbre respecto de la evolución de la enfermedad.

Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children.

BACKGROUND: Dietary fluoride supplements were first introduced to provide systemic fluoride in areas where water fluoridation is not available. Since 1990, the use of fluoride supplements in caries prevention has been re-evaluated in several countries. OBJECTIVES: To evaluate the efficacy of fluoride supplements for preventing dental caries in children. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 12 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE via OVID (1950 to 12 October 2011), EMBASE via OVID (1980 to 12 October 2011), WHOLIS/PAHO/MEDCARIB/LILACS/BBO via BIREME (1982 to 12 October 2011), and Current Controlled Trials (to 12 October 2011). We handsearched reference lists of articles and contacted selected authors. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials comparing, with minimum follow-up of 2 years, fluoride supplements (tablets, drops, lozenges) with no fluoride supplement or with other preventive measures such as topical fluorides in children less than 16 years of age at the start. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (DMFS). DATA COLLECTION AND ANALYSIS: Two review authors, independently and in duplicate, assessed the eligibility of studies for inclusion, and carried out risk of bias assessment and data extraction. In the event of disagreement, we sought consensus and consulted a third review author. We contacted trial authors for missing information. We used the prevented fraction (PF) as a metric for evaluating the efficacy of the intervention. The PF is defined as the mean caries increment in controls minus mean caries increment in the treated group divided by mean caries increment in controls. We conducted random-effects meta-analyses when data could be pooled. We assessed heterogeneity in the results of the studies by examining forest plots and by using formal tests for homogeneity. We recorded adverse effects (fluorosis) when the studies provided relevant data. MAIN RESULTS: We included 11 studies in the review involving 7196 children.In permanent teeth, when fluoride supplements were compared with no fluoride supplement (three studies), the use of fluoride supplements was associated with a 24% (95% confidence interval (CI) 16 to 33%) reduction in decayed, missing and filled surfaces (D(M)FS). The effect of fluoride supplements was unclear on deciduous or primary teeth. In one study, no caries-inhibiting effect was observed on deciduous teeth while in another study, the use of fluoride supplements was associated with a substantial reduction in caries increment.When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth.The review found limited information on the adverse effects associated with the use of fluoride supplements. AUTHORS' CONCLUSIONS: This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.

Round robin test: wear of nine dental restorative materials in six different wear simulators - supplement to the round robin test of 2005.

OBJECTIVE: The purpose of the present study was to submit the same materials that were tested in the round robin wear test of 2002/2003 to the Alabama wear method. METHODS: Nine restorative materials, seven composites (belleGlass, Chromasit, Estenia, Heliomolar, SureFil, Targis, Tetric Ceram) an amalgam (Amalcap) and a ceramic (IPS Empress) have been submitted to the Alabama wear method for localized and generalized wear. The test centre did not know which brand they were testing. Both volumetric and vertical loss had been determined with an optical sensor. After completion of the wear test, the raw data were sent to IVOCLAR for further analysis. The statistical analysis of the data included logarithmic transformation of the data, the calculation of relative ranks of each material within each test centre, measures of agreement between methods, the discrimination power and coefficient of variation of each method as well as measures of the consistency and global performance for each material. RESULTS: Relative ranks of the materials varied tremendously between the test centres. When all materials were taken into account and the test methods compared with each other, only ACTA agreed reasonably well with two other methods, i.e. OHSU and ZURICH. On the other hand, MUNICH did not agree with the other methods at all. The ZURICH method showed the lowest discrimination power, ACTA, IVOCLAR and ALABAMA localized the highest. Material-wise, the best global performance was achieved by the leucite reinforced ceramic material Empress, which was clearly ahead of belleGlass, SureFil and Estenia. In contrast, Heliomolar, Tetric Ceram and especially Chromasit demonstrated a poor global performance. The best consistency was achieved by SureFil, Tetric Ceram and Chromasit, whereas the consistency of Amalcap and Heliomolar was poor. When comparing the laboratory data with clinical data, a significant agreement was found for the IVOCLAR and ALABAMA generalized wear method. SIGNIFICANCE: As the different wear simulator settings measure different wear mechanisms, it seems reasonable to combine at least two different wear settings to assess the wear resistance of a new material.

Predictors of endocarditis in isolates from cultures of blood following dental extractions in rats with periodontal disease.

Rats with periodontitis and catheter-induced aortic valve vegetations underwent dental extractions. Cultures of blood obtained 1 min later showed polymicrobial bacteremia in 19 of 19 rats, mostly due to viridans streptococci (18 of 19), Morganella (15 of 19), group G streptococci (13 of 19), and Staphylococcus aureus (10 of 19). Viridans streptococci circulated in higher numbers than did group G streptococci and S. aureus (P less than .01). Three days after dental extractions, 18 of 20 rats had endocarditis. Fifteen (83%) of 18 infections were due to group G streptococci, 9 (50%) of 18 were due to S. aureus, and 2 (11%) of 18 were due to viridans streptococci (P less than .05). In vitro, adherence to platelet-fibrin matrices of endocarditis strain 8 of group G streptococcus was two times greater than that of endocarditis strain S. aureus 23 and three to four times greater than that of Streptococcus sanguis 44 and Morganella morganii 93 (P less than 10(-5)). The inoculum size that produced endocarditis in 90% of rats after iv challenge was 10(5) cfu for group G streptococcus strain 8 and 10(7) for S. sanguis 44.

Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study

BACKGROUND: While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years. METHODS: Repeated population-based surveys (2007-2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. RESULTS: A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥ 13,000 CHF, 1 CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000 CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000 CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy. CONCLUSIONS: In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care.

Coocurrencia entre ansiedad y autismo: Las hipótesis del error social y de la carga alostática

Introducción. El concepto de comorbilidad en trastornos del neurodesarrollo como el autismo resulta, en ocasiones, ambiguo. La coocurrencia entre ansiedad y autismo es clínicamente signifi cativa; sin embargo, no siempre es fácil diferenciar si se trata de una comorbilidad"real", donde las dos condiciones comórbidas son fenotípica y etiológicamente idénticas a lo que supondría dicha ansiedad en personas con un desarrollo neurotípico; si se trata de una ansiedad fenotípicamente alterada por los procesos patogénicos de los trastornos del espectro autista, resultando en una variante específica de éstos, o si partimos de una comorbilidad falsa derivada de diagnósticos diferenciales poco exactos. Desarrollo. El artículo plantea dos hipótesis explicativas de dicha coocurrencia, que se retroalimentan entre sí y que no dejan de ser una refl exión en voz alta partiendo de las evidencias científi cas con las que contamos. La primera es la hipótesis del"error social", y considera que el desajuste en el comportamiento social de las personas con autismofruto de alteraciones en los procesos de cognición social contribuye a exacerbar la ansiedad en el autismo. La segunda hipótesis, la de la carga alostática, defi ende que la ansiedad es la respuesta a un estrés crónico, al desgaste o agotamiento que produce la hiperactivación de ciertas estructuras del sistema límbico. Conclusiones. Las manifestaciones prototípicas de la ansiedad presentes en la persona con autismo no siempre se relacionan con las mismas variables biopsicosociales evidenciadas en personas sin autismo. Las evidencias apuntan a respuestas hiperreactivas de huida o lucha (hipervigilancia) cuando la persona se encuentra fuera de su zona de confort, y apoyan la hipótesis del"error social" y de la descompensación del mecanismo de alostasis que permite afrontar el estrés.

Estudio de la reminiscencia y el rendimiento en función de la ansiedad inducida mediante consigna, en un tipo de tarea sensoriomotriz

El objetivo fundamental de este trabajo ha sido el intento de estudiar la posible relación entre la ansiedad como una disposición activadora estable del sujeto, y la motivación. Suscitada mediante consigna. Si bien los resultados no han sido estadisticamente concluyentes, a partir del análisis cualitativo de 10s mismos, parece, en principio, deducirse la real interacción entre 10s factores de activaci6n y motivación inducida. Por otra parte, si bien la prueba de la hip6tesis se fundamenta en medidas de rerniniscencia, ha sido establecida una nueva medici6n de la motivación en función de la persistencia.

Correlación entre diversos cuestionarios de ansiedad y depresión

En nuestra práctica clínica observamos la insuficiencia de los cuestionarios como método diagnostico, especialmente cuando se trata de establecer diferencias cualitativas entre cuadros de angustia y depresión. Esta hipótesis se ha confirmado al realizar correlaciones entre 6 cuestionarios (tres de angustia y tres de depresión), que se administraron a 41 pacientes (28 angustiados y 13 depresivos) y observar el elevado indice de interrelaciones existentes entre ellos. Los pacientes depresivos tienden a puntuar alto, tanto en los cuestionarios de depresión como en los de angustia, mientras que los angustiados solo lo hacen en estos últimos.

Ansiedad y depresión en parejas que incian un tratamiento de fecundación in vitro (FIV): rol de las estrategias de afrontamiento

Living with infertility and its emotional impact in couples has been frequently investigated. The objective of the present study was to establish in couples that initiate an IVF treatment:(1) their coping profile, anxiety level (State-anxiety; Trait-anxiety) and depression symptomatology;(2) the explanatory power of coping strategies over anxiety and depression levels, depending on gender. Method: we used a transversal study with 92 couples that begun an IVF treatment in the Assisted Reproduction Unit of the Hospital Clinic. All of them respond to the Spanish adaptation of the CRI-A, the STAI and the BDI-I. Results: the IVF population in comparison to the normal sample use less coping strategies and presents lower levels of anxiety and depression. Women IVF in comparison with man employ further avoidance strategies and present a higher score in depression and state-anxiety. Even when some exceptions exist, anxiety and depression levels are not well explained by coping strategies. Conclusions: It has been shown that the use of coping strategies on the IVF population are lower than in normative sample. Most of the couples present low anxiety (state / trait) and depression levels, and just a low percentage present scores that can require clinical attention. Key words: Infertility / IVF / Coping strategies / State anxiety / Trait anxiety / depression.

Pautas de conducta frente a los pacientes bajo tratamiento anticoagulante en la clínica dental.

Nuestro trabajo pretende dar unas ideas básicas para el manejo de pacientes sometidos a tratamiento anticoagulante dando a conocer las posibles pautas a seguir respecto a su medicación: mantener intacta la terapia anticoagulante, modificar la terapia anticoagulante o realizar tratamiento combinado de heparina con anticoagulantes orales. La decisión deberá tomarse conjuntamente con el hematólogo responsable del paciente valorando cada caso según la morbilidad intrínseca de la intervención, el riesgo de tromboembolismo en función de la patología de base que presente el paciente y el grado de coagulación determinado mediante estudios de laboratorio (tiempo de protrombina e índice de trombotest).