A Novel Approach to Intraoral Mandibular Nerve Anesthesia: Changing Reference Planes in the Gow-Gates Block Technique

Purpose: The Gow-Gates technique is said to have several advantages over traditional techniques to achieve mandibular nerve anesthesia; however, its routine use is quite limited, mainly due to complications during visual alignment of reference landmarks. The purpose of this study was to verify the validity and accuracy of a new method to reach the injection site. Material and Methods: Fifteen magnetic resonance images were captured. Distances from the ideal injection point in the condylar neck (puncture ideal) to the injection points located in the a and 0 plane intersection (Puncture Gow-Gates and puncture modified) were measured and compared. Results: Positive and significant (P <= .003) Pearson correlations between landmarks and injection points confirmed the validity of the modified technique. Paired t test showed that the segment line puncture ideal-puncture modified, 5.17 mm, was 3 times shorter (P < .001) than the segment line puncture ideal-puncture Gow-Gates, 17.91 mm. As calculated by linear regression, establishing the injection point of the modified technique depended only on the anteroposterior and lateromedial condyle positions. Conclusions: The modified technique proved to be valid and precise and has a determined and an effective injection site. (C) 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:2609-2616, 2009

Accuracy of direct digital radiography for detecting occlusal caries in primary teeth compared with conventional radiography and visual inspection: an in vitro study

Objectives: The diagnosis of caries lesions is still a matter of concern in dentistry. The diagnosis of dental caries by digital radiography has a number of advantages over conventional radiography; however, this method has not been explored fully in the field of paediatric dentistry. This in vitro research evaluated the accuracy of direct digital radiography compared with visual inspection and conventional radiography in the diagnosis of occlusal caries lesions in primary molars. Methods: 50 molars were selected and evaluated under standardized conditions by 2 previously calibrated examiners according to 3 diagnostic methods (visual inspection, conventional radiography and direct digital radiography). Direct digital radiographs were obtained with the Dixi3 system (Planmeca, Helsinki, Finland) and the conventional radiographs with InSight film (Kodak Eastman Co., Rochester, NY). The images were scored and a reference standard was obtained histologically. The interexaminer reliability was calculated using Cohen`s kappa test and the specificity, sensitivity and accuracy of the methods were calculated. Results: Examiner reliability was good. For lesions limited to the enamel, visual inspection showed significantly higher sensitivity and accuracy than both radiographic methods, but no significant difference was found in specificity. For teeth with dentinal caries, no significant differences were found for any parameter when comparing visual and radiographic evaluation. Conclusions: Although less accurate than the visual method for detecting caries lesions confined to the enamel, the direct digital radiographic method is as effective as conventional radiographic examination and visual inspection of primary teeth with occlusal caries when the dentine is involved. Dentomaxillofacial Radiology (2010) 39, 362-367. doi: 10.1259/dmfr/22865872

Ethanol Wet-bonding Challenges Current Anti-degradation Strategy

The long-term effectiveness of chlorhexidine as a matrix metalloproteinase (MMP) inhibitor may be compromised when water is incompletely removed during dentin bonding. This study challenged this anti-bond degradation strategy by testing the null hypothesis that wet-bonding with water or ethanol has no effect on the effectiveness of chlorhexidine in preventing hybrid layer degradation over an 18-month period. Acid-etched dentin was bonded under pulpal pressure simulation with Scotchbond MP and Single Bond 2, with water wet-bonding or with a hydrophobic adhesive with ethanol wet-bonding, with or without pre-treatment with chlorhexidine diacetate (CHD). Resin-dentin beams were prepared for bond strength and TEM evaluation after 24 hrs and after aging in artificial saliva for 9 and 18 mos. Bonds made to ethanol-saturated dentin did not change over time with preservation of hybrid layer integrity. Bonds made to CHD pre-treated acid-etched dentin with commercial adhesives with water wet-bonding were preserved after 9 mos but not after 18 mos, with severe hybrid layer degradation. The results led to rejection of the null hypothesis and highlight the concept of biomimetic water replacement from the collagen intrafibrillar compartments as the ultimate goal in extending the longevity of resin-dentin bonds.

Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces

Purpose: To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces. Methods: 72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen`s kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated. Results: VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. On the other hand, radiographic examination and laser fluorescence were less efficient when used alone.

A responsible gambling strategy for older Queenslanders: Final Report

This study investigates the needs, experiences, behaviours and attitudes of older Queenslanders who participate in gambling. It aims to understand the special needs and circumstances of older Queensland gamblers which might make them particularly vulnerable to problem gambling behaviour, or other negative effects of gambling. The findings of the research will provide an evidence base for the development of initiatives and policies that can address the specific prevention, protection and rehabilitation needs of older gamblers. This is with a particular view to informing the ongoing development and implementation of the Queensland Government’s Responsible Gambling Strategy and its voluntary industry code – the Queensland Responsible Gambling Code of Practice.

GP5+/6+ SYBR Green methodology for simultaneous screening and quantification of human papillomavirus

Background: Detection and quantification of human papillomavirus (HPV) may help in predicting the evolution of HPV infection and progression of associated lesions. Objectives: We propose a novel protocol using consensus primers GP5+/6+ in a SYBR Green quantitative real-time (Q-RT) polymerase chain reaction (PCR). The strategy permits screening for HPV infection and viral load quantification simultaneously. Study design: DNA from 153 archived cervical samples, previously tested for HPV detection by GP5+/6+ PCR and typed by EIA-RLB (enzyme immunoassay-reverse line blot) or sequence analysis, was analysed using SYBR Green Q-RT PCR. Melting temperature assay (T(m)) and cycle threshold (C(t)) were used to evaluate HPV positivity and viral load. The T(m) in the range of 77-82 degrees C was considered to be positive for HPV-DNA. HPV results generated through GP5+/6+ conventional PCR were considered the gold standard against which sensitivity and specificity of our assay were measured. Results: Out of 104 HPV positive samples, 100 (96.2%) were also determined as positive by SYBR Green Q-RT PCR; of the 49 HPV-negative samples, all were determined as negative. There was an excellent positivity agreement (K = 0.94) between the SYBR Green Q-RT and the previous methods employed. The specificity and sensitivity were 100% and 96.2%, respectively. Comparison of SYBR Green Q-RT and TaqMan oligo-probe technologies gave an excellent concordance (pc = 0.95) which validated the proposed strategy. Conclusions: We propose a sensitive and easy-to-perform technique for HPV screening and viral load quantification simultaneously. (C) 2009 Elsevier B.V. All rights reserved.

Influence of the menstrual cycle on the pressure pain threshold of masticatory muscles in patients with masticatory myofascial pain

Objective. The aim of this study was to investigate the influence of the menstrual cycle and oral contraceptive (OC) intake on the pressure pain threshold (PPT) of masticatory muscles in patients with masticatory myofascial pain (MFP). Study design. The sample was composed of 36 women, divided into 4 groups, according to the presence of MFP and the intake of OC (15 patients had MFP [7 taking OC] and 21 were pain-free controls [8 taking OC]). The algometer-based PPT of masseter and temporalis, and the record of subjective pain by visual analog scale (VAS) were determined during 2 consecutives menstrual cycles at 4 phases (menstrual, follicular, periovulatory, and luteal). A 3-way ANOVA for repeated measurements, Kruskal-Wallis, Friedman, and Dunn tests, with a 5% significant level analyzed the data. Results. PPT was significantly lower in MFP patients when compared with controls throughout the experiment (P < .001). The menstrual phases did not influence PPT (P > .05), while the intake of OC seems to raise PPT levels for the left temporalis (P = .01) and right masseter (P = .04). VAS was, in general, higher at the menstrual phase Conclusions. Different phases of the menstrual cycle have no influence on PPT values, regardless of the presence of a previous condition, as masticatory myofascial pain, while the intake of OC is associated with decreased levels of reported pain.

The anatomy of two-rooted mandibular canines determined using micro-computed tomography

P>Aim To investigate the internal and external anatomy of extracted human mandibular canines with two roots and two distinct canals using micro-computed tomography (mu CT). Methodology Fourteen two-rooted human mandibular canines were scanned using a high-resolution mu CT system (SkyScan 1174v2; SkyScan N.V., Kontich, Belgium). The images were processed to evaluate the size of the roots, the furcation regions, the presence of accessory canals, the mean distances between several anatomical landmarks, the position of the apical foramina, the direction of root curvatures, the cross-sectional appearances (SMI index), the volume and surface areas of the root canals. Results Root bifurcation was located in both apical (44%, n = 6) and middle (58%, n = 8) thirds of the root. The size of the buccal and lingual roots was similar in 29% of the sample. From a buccal view, no curvature towards the lingual or buccal direction occurred in either roots. From a proximal view, no straight lingual root occurred. In both views, S-shaped roots were found in 21% of the specimens. Location of the apical foramen varied considerably, tending to the mesio-buccal aspect of both roots. Lateral and furcation canals were observed mostly in the cervical third in 29% and 65% of the sample, respectively. The structure model index (SMI) index ranged from 1.87 to 3.86, with a mean value of 2.93 +/- 0.46. Mean volume and area of the root canals were 11.52 +/- 3.44 mm3 and 71.16 +/- 11.83 mm2, respectively. Conclusions The evaluation of two-rooted mandibular canines revealed that bifurcations occurred in the apical and middle third. S-shaped roots were found in 21% of the specimens. Mean volume, surface area and SMI index of the root canals were 11.52 mm3, 71.16 mm2 and 2.93, respectively.