Integrated biosensors: promises and problems

After a brief review of the biosensors area, this paper explores the possibilities of integrating various classes of biosensors on silicon. Of all classes of sensors, electrochemical and bioelectrochemical sensors are the most suitable for integration, although substantial research on the fabrication and understanding of bioactive layers on semiconductor sensors is still required. Optical, gravimetric and thermal sensors could also be integrated to varying extents; however, the cost benefits are not yet very attractive except for immunosensors based on immobilized immunoglobulins. Electrochemical and gravimetric sensors based on silicon show the greatest potential for batch fabrication and could therefore be best suited for disposable sensors. The review ends with a discussion of the technological, functional and conceptual problems associated with integrated biosensors.     

Professional promises: Summary and next steps

A summary of the key themes discussed during the sessions is provided highlighting the participants' recommendations for addressing the ethics of access. Areas reviewed included strategies utilizing ethics as an educational tool. The need for professional associations and accrediting and licensing bodies to address access to care in their guidelines is an additional recommendation. Networking, sharing resources, and continuing the dialogue about ethics and access to care are identified as important strategies following the workshop. The summary also highlights promises made to continue the dialogue about the issue in various forums.     

The future of dental ethics: promises needed

The future development of professional dental ethics requires a core group of dentists well-trained in ethics: teachers, scholars, and researchers who are also firmly grounded in the clinical aspects of the profession.This will require a significant increase in the number of individuals who can work with a range of moral views, ethical communities, and religious traditions. Proposals for addressing this situation include: the creation of a dental ethics institute, the funding of an endowed dental ethics chair, a one-year professional dental ethics fellowship program, the development of a program of ethics certification, and the initiation of a "positive ethics" self-assessment program designed specifically for dental practices and organizations. Systemic and philanthropic efforts from dental organizations will be needed to support these endeavors. Some can be initiated through existing programs and organizations.     

Vaccination and periodontitis: myth or reality

In most industrialised countries approximately 15% of the population has enhanced risk for moderate to severe periodontitis. The disease is caused by infection by gram-negative, anaerobic bacteria including Porphyromonas gingivalis and Bacteroides forsythus. There is evidence that P. gingivalis is a key pathogen. Using ligature-induced periodontitis in the non-human primate Macaca fascicularis as a model, we immunised 10 animals using intact killed P. gingivalis and SAF-M adjuvant and 10 controls using adjuvant only. The vaccine, containing 250 microg protein/ml, was injected subcutaneously in the neck and into the deltoid muscle (0.5 ml each site) at baseline and weeks 3, 6, and 16, and the mandibular posterior teeth ligated at week 16. At weeks 30 and 36 changes in alveolar bone, measured using digital subtraction radiography, were used as the outcome measure. Even though periodontitis in humans and in this animal model is a polymicrobial disease, immunisation with a vaccine containing a single bacterial species, P. gingivalis, induced protection. Of all the P. gingivalis components that have been studied, the cysteine proteases have the greatest potential as vaccine antigens. In a pilot study using the same protocol, we have shown that porphypain-2 purified from P. gingivalis is effective in inducing protection. Although opsonisation and bacterial cell killing may be involved in protection, other mechanisms such as antibody mediated reduction of levels of inflammatory mediators such as PGE2 and neutralisation of virulence factors may be important. In neither the whole cell vaccine nor the purified cysteine protease vaccine studies were signs of toxicity observed. In light of the increasing evidence that periodontitis significantly increases risk for potentially fatal diseases such as coronary heart disease, stroke and complications from diabetes mellitus a successful vaccine for periodontitis could have health benefits far exceeding the prevention of periodontitis.     

Digitized impressions: myth and daily reality

The digitizing of impressions, or models made from them, opens, in the same way that digitized 3D X-rays did, new horizons for practitioners in the management for their offices, in their interactions with patients, and in their shared work with dental laboratories. Mastery of digitized models improves the efficiency and reinforces the quality of dental treatment through the new perspectives digital analyses provide. Finally the maintenance of records is greatly simplified in far less space while still respecting all pertinent legal requirements, thus assuring total suitability for all current regulations.     

Occlusion: reflections on science and clinical reality

The last 50 years have seen progress in emphasizing scientific evidence as a basis for dental practice, including occlusal therapy. Although a proper understanding of the contributory role of occlusion to temporomandibular disorders should not be minimized, the importance of occlusion in other areas of dental education and practice should not be overlooked. The primary objective of this article is to discuss the nature of this problem as it relates to the duality of science and clinical reality in the evidence-based paradigm, information transfer, quality of evidence, clinical trials, and clinical aspects of occlusion. Some suggested solutions for the problem and thoughts on past and future perspectives of occlusion are expressed in context of inquiry.     

Informed consent: optimism versus reality

OBJECTIVE: To determine whether parents of children attending the outpatient general anaesthesia (OPGA) session at the Eastman Dental Hospital, London fully understand the proposed treatment. DESIGN: Observational study supported by structured questionnaires and interviews. SETTING: Casualty service in the Department of Paediatric Dentistry and the Victor Goldman Unit (a day-stay general anaesthetic unit) of the Eastman Dental Hospital. MAIN OUTCOME MEASURES: The parents' understanding of the consent was assessed based on their knowledge of the actual treatment procedure, the type of anaesthesia to be used and the number and type of teeth that would be extracted. RESULTS: Fifty-two of the 70 subjects (74%) approached completed both parts of the survey (interviews one and two). Results showed that 40% of the written consent obtained from the parents were not valid. The subjects' knowledge of the proposed treatment improved on the day of the actual treatment although 19% of them still did not fully understand the procedure. There was a statistically significant increase in the proportion of valid consent on the day of the actual treatment. Many of the subjects had no knowledge of the type of anaesthesia that would be used for their children but were more aware of the number and type of teeth that were going to be extracted. The time interval between the consent process and the actual treatment did not have any significant effect on the subjects' understanding of the consent, but it implied that with time the subjects' knowledge improved. CONCLUSION: A proportion of subjects did not fully understand the proposed treatment procedure even after being adequately informed. Appropriate measures should be taken to ensure that the patients or their guardians truly understand the proposed treatment.     

Dentists' views on fearful patients. Problems and promises

A large number of patients treated in the general dental health service in Western countries report dental fear to some degree. Dentists' views of treating these fearful patients are not well described in the literature.Therefore, the aims of the study were to explore dentists' attitudes towards, experience of, and feelings about treating fearful patients. The sample consisted of 1293 members of the Association of Public Health Dentists in Sweden who were asked to respond to a web survey concerning dental fear. The response rate was 69% (n = 889).The majority of the responding dentists stated that dental fear is a problem in routine dental care,treating patients with dental fear is a positive challenge and they felt they were making a contribution.They also reported that treating patients with dental fear is associated with hard work, poor revenues, and little appreciation by employers. Female dentists reported a greater proportion of patients with dental fear and greater self-efficacy regarding the treatment of these patients, compared with their male colleagues. Dentists trained in other EU countries reported stress more often and less perceived contribution when treating fearful patients, compared with colleagues trained in Sweden. CONCLUSION: Dentists' views of treating fearful patients are mainly positive; however, it is problematic that dentists feel stress and that dentists who treat many fearful patients feel their employers do not appreciate their efforts.