Human dental enamel and dentin structural effects after Er:yag laser irradiation

Ideally projected to be applied on soft tissues, infrared lasers were improved by restorative dentistry to be used in hard dental tissues cavity preparations-namely enamel and dentin. This paper evidentiates the relevant aspects of infrared Erbium laser's action mechanism and its effects, and characterizes the different effects deriving from the laser's beams emission. The criteria for use and selection of optimal parameters for the correct application of laser systems and infuence of supporting factors on the process, such as water amount and its presence in the ablation process, protection exerted by the plasma shielding and structural factors, which are indispensable in dental tissues cavity preparation related to restorative technique, are subordinated to optical modifcations caused by the interaction of the energy dissipated by these laser light emission systems in the targeted tissue substrate. Clinical relevance: Differences in the action of infrared Erbium laser system in regard to the nature of the ablation process and variations on the morphological aspects observed in the super-fcial structure of the target tissue irradiated, may be correlated to the structural optical modifcations of the substrate produced by an interaction of the energy propagated by laser systems.

Dental students familiarity with the implications of using local anesthetics and dental materials

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Occurrence and types of dental injuries among patients with maxillofacial fractures

The aim of this retrospective study was to clarify the occurrence and types of dental injuries in 389 patients who had been diagnosed with facial fractures, and to analyze whether the occurrence of dental injury correlates to gender, age, trauma mechanism and type of facial fracture. Dental injuries were observed in 62 patients (16%). The most common type of injury was a crown fracture (48%). Dental injuries were multiple in most patients (63%). Almost half (48%) of all injured teeth were severely injured. Most injured teeth (61%) were in the maxilla. The incisor region was the most prevalent site in both the mandible (45%) and the maxilla (56%). The occurrence of dental injury correlated significantly with trauma mechanism and fracture type: motor vehicle accidents and mandibular fracture were significant predictors for dental trauma. The notable rate of dental injury observed in the present study emphasizes the importance of a thorough examination of the oral cavity in all patients who have sustained facial fracture. Referral to a dental practice for further treatment and follow up as soon as possible after discharge from hospital is fundamental.

Prevalence of findings compatible with carotid artery calcifications on dental panoramic radiographs

Cerebrovascular accidents are responsible for killing or disabling more than half a million Americans every year. They are the third leading cause of death in this country. In Germany, the annual stroke incidence reaches 182 cases per 100,000 inhabitants. Stroke there is the fourth leading cause of death. There is a need of finding cost-effective means of decreasing stroke mortality and morbidity. Instruments for early diagnosis are of great humanitarian and economic importance. All possible clinical findings should be taken into account. It is not the demand of this study to present the panoramic radiograph as a screening test method for early diagnosis of atherosclerosis. The aim is to show the potential of this radiograph used in everyday clinical dental practice by the prevalence of radiopaque findings in the carotid region. This study included panoramic dental radiographs of 2,557 patients older than 30 years of age. Fifty-nine percent of the patients were women and 41% were men. The radiographs were adjudged for signs compatible with carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below the intervertebral space C3-4. Of all these radiographs, 4.8% showed radiopaque findings compatible with atherosclerotic lesions. The proportion of women reached 64.8% and that of men reached 35.2%. In accordance to recent literature, the results of this study show that about 5% of the patients show radiological findings compatible with carotid arterial calcifications. Some of these patients at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph. The suspicion of carotid artery calcifications demands an impetuous referral to an appropriate practitioner who can assist in the control of risk factors and if necessary arrange surgical removal of the carotid arterial plaque. So, the dentist should be aware of this problem and able to make a contribution to stroke prevention.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Assessment of publication bias in dental specialty journals

OBJECTIVE: The purpose of this study was to investigate the presence of publication bias (acceptance of articles indicating statistically significant results). METHODS: The journals possessing the highest impact factor (2008 data) in each dental specialty were included in the study. The content of the 6 most recent issues of each journal was hand searched and research articles were classified into 4 type categories: cross-sectional, case-control, cohort, and interventional (nonrandomized clinical trials and randomized controlled trials). In total, 396 articles were included in the analysis. Descriptive statistics and univariate and multivariate logistic regression was used to examine the association between article-reported statistical significance (dependent variable) and journal impact factor and article study type subject area (independent variables). RESULTS: A statistically significant acceptance rate of positive result was found, ranging from 75% to 90%, whereas the value of impact factor was not related to publication bias among leading dental journals. Compared with other research designs, clinical intervention studies (randomized or nonrandomized) presented the highest percentage of nonsignificant findings (20%); RCTs represented 6% of the examined investigations. CONCLUSIONS: Compared with the Journal of Clinical Periodontology, all other subspecialty journals, except the Journal of Oral and Maxillofacial Surgery, showed significantly decreased odds of publishing an RCT, which ranged from 60% to 93% (P < .05).

Reporting of research quality characteristics of studies published in 6 major clinical dental specialty journals

The objective of this article was to record reporting characteristics related to study quality of research published in major specialty dental journals with the highest impact factor (Journal of Endodontics, Journal of Oral and Maxillofacial Surgery, American Journal of Orthodontics and Dentofacial Orthopedics; Pediatric Dentistry, Journal of Clinical Periodontology, and International Journal of Prosthetic Dentistry). The included articles were classified into the following 3 broad subject categories: (1) cross-sectional (snap-shot), (2) observational, and (3) interventional. Multinomial logistic regression was conducted for effect estimation using the journal as the response and randomization, sample calculation, confounding discussed, multivariate analysis, effect measurement, and confidence intervals as the explanatory variables. The results showed that cross-sectional studies were the dominant design (55%), whereas observational investigations accounted for 13%, and interventions/clinical trials for 32%. Reporting on quality characteristics was low for all variables: random allocation (15%), sample size calculation (7%), confounding issues/possible confounders (38%), effect measurements (16%), and multivariate analysis (21%). Eighty-four percent of the published articles reported a statistically significant main finding and only 13% presented confidence intervals. The Journal of Clinical Periodontology showed the highest probability of including quality characteristics in reporting results among all dental journals.

Mislabeling controlled clinical trials (CCTs) as "randomized clinical trials (RCTs)" in dental specialty journals

This study aimed to investigate whether studies published in dental journals with the highest impact factor, representing the 5 major dental specialties and titled as randomized clinical trials (RCTs) are truly RCTs. A second objective was to explore the association of journal type and other publication characteristics on correct classification.

Testing strategies and follow-up for coeliac disease in a general internal medicine outpatient department from 2000 to 2005

PRINCIPLES: Coeliac disease (gluten sensitive enteropathy) is a genetically determined disorder with an incidence in the general population that is comparable to type 2 diabetes mellitus. Awareness of this fact and of the often atypical and oligosymptomatic manifestations is only now gaining ground in the medical profession. A high index of suspicion is important in order to minimise diagnostic and therapeutic delay. METHODS: Testing patterns and follow-up for coeliac disease in our institution have been analysed retrospectively for the past five years. The current literature was reviewed with respect to recommendations for clinical practice. RESULTS: A total of 271 patients were tested for coeliac disease over a period of five years. Only in 24 patients were positive results found; after further work-up, the final number of cases with certain or presumed coeliac disease was four. Followup was often difficult, many patients being lost after a single visit. CONCLUSIONS: This study showed that the number of tests ordered in our institution, more often for abdominal than atypical symptoms, has started to increase in the past two years. It also showed that screening tests have found their place in general clinical practice, while the final choice of tests needs to be determined in accordance with available guidelines and local resources. Upper endoscopy with small bowel biopsy remains the gold standard for diagnosis, but its place in follow-up is less certain. Coeliac disease is a disorder for which there is a definite treatment (gluten free diet); if it is left untreated diminished quality of life and potentially serious complications may ensue. Further education of the medical profession regarding coeliac disease, its incidence, presentation and treatment, is clearly indicated..

Basic Erosive Wear Examination (BEWE): a new scoring system for scientific and clinical needs

A new scoring system, the Basic Erosive Wear Examination (BEWE), has been designed to provide a simple tool for use in general practice and to allow comparison to other more discriminative indices. The most severely affected surface in each sextant is recorded with a four level score and the cumulative score classified and matched to risk levels which guide the management of the condition. The BEWE allows re-analysis and integration of results from existing studies and, in time, should initiate a consensus within the scientific community and so avoid continued proliferation of indices. Finally, this process should lead to the development of an internationally accepted, standardised and validated index. The BEWE further aims to increase the awareness of tooth erosion amongst clinicians and general dental practitioners and to provide a guide as to its management.

Reporting quality of abstracts of randomized controlled trials published in dental specialty journals

OBJECTIVES A widespread assessment of the reporting of RCT abstracts published in dental journals is lacking. Our aim was to investigate the quality of reporting of abstracts published in leading dental specialty journals using, as a guide, the CONSORT for abstracts checklist. METHODS Electronic and supplementary hand searching were undertaken to identify RCTs published in seven dental specialty journals. The quality of abstract reporting was evaluated using a modified checklist based on the CONSORT for abstracts checklist. Descriptive statistics followed by univariate and multivariate analyses were conducted. RESULTS 228 RCT abstracts were identified. Reporting of interventions, objectives and conclusions within abstracts were adequate. Inadequately reported items included: title, participants, outcomes, random number generation, numbers randomized and effect size estimate. Randomization restrictions, allocation concealment, blinding, numbers analyzed, confidence intervals, intention-to-treat analysis, harms, registration and funding were rarely described. CONCLUSIONS The mean overall reporting quality score was suboptimal at 62.5% (95% CI: 61.9, 63.0). Significantly better abstract reporting was noted in certain specialty journals and in multicenter trials.

Are sample sizes clear and justified in RCTs published in dental journals?

Sample size calculations are advocated by the CONSORT group to justify sample sizes in randomized controlled trials (RCTs). The aim of this study was primarily to evaluate the reporting of sample size calculations, to establish the accuracy of these calculations in dental RCTs and to explore potential predictors associated with adequate reporting. Electronic searching was undertaken in eight leading specific and general dental journals. Replication of sample size calculations was undertaken where possible. Assumed variances or odds for control and intervention groups were also compared against those observed. The relationship between parameters including journal type, number of authors, trial design, involvement of methodologist, single-/multi-center study and region and year of publication, and the accuracy of sample size reporting was assessed using univariable and multivariable logistic regression. Of 413 RCTs identified, sufficient information to allow replication of sample size calculations was provided in only 121 studies (29.3%). Recalculations demonstrated an overall median overestimation of sample size of 15.2% after provisions for losses to follow-up. There was evidence that journal, methodologist involvement (OR = 1.97, CI: 1.10, 3.53), multi-center settings (OR = 1.86, CI: 1.01, 3.43) and time since publication (OR = 1.24, CI: 1.12, 1.38) were significant predictors of adequate description of sample size assumptions. Among journals JCP had the highest odds of adequately reporting sufficient data to permit sample size recalculation, followed by AJODO and JDR, with 61% (OR = 0.39, CI: 0.19, 0.80) and 66% (OR = 0.34, CI: 0.15, 0.75) lower odds, respectively. Both assumed variances and odds were found to underestimate the observed values. Presentation of sample size calculations in the dental literature is suboptimal; incorrect assumptions may have a bearing on the power of RCTs.

From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia

Objectives To explore how general practitioners have accessed and evaluated evidence from trials on the use of statin lipid lowering drugs and incorporated this evidence into their practice. To draw out the practical implications of this study for strategies to integrate clinical evidence into general medical practice.

Oral cancer awareness for the general practitioner: new approaches to patient care

In Australia, oral cancer accounts for approximately 2-3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. The incidence of intra-oral cancer is gradually increasing. It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients, and as such it is the responsibility of dentists to identify such lesions early. To facilitate early detection of suspicious oral lesions several clinical methods of detection can be used. In addition to conventional visual screening of oral tissues with the naked eye under projected incandescent or halogen illumination, there are many clinical diagnostic aids that can be undertaken to help detect oral cancer. In this article we explore clinically available modalities that may be used by the general dental practitioner, and highlight their inherent strengths and weaknesses.