Oral health, dental treatment, and cardiac valve surgery outcomes

The aim of this study was to determine whether not treating chronic dental infection during the admission for cardiac valve surgery would increase the morbidity and mortality of patients.
Patients were divided into three groups: dentally unhealthy and untreated (Group A), dentally healthy not requiring treatment (Group B), and dentally unhealthy and treated (Group C). Hospital computer records and phone interviews were used to assess morbidity and mortality as assessed through the Social Security Death Index.
Ninety-eight patient charts were reviewed. Patients in Group A (n = 47)were not at a significantly greater risk for developing infective endocarditis (IE) within 6 months of cardiac surgery compared to patients in Groups B (n = 17) and C (n = 34). Also, patients in Group A did not have a significantly higher rate of mortality compared to other groups ( p = .09).
The results suggest that there is no need to treat chronic oral infections in patients with compromised cardiac function within 24 to 48 hours prior to cardiac valve replacement surgery since this will not lower the risk of IE and death following cardiac valve surgery. Multicenter prospective case-controlled studies are needed to address this question definitively.     

Effect of stress on information processing in the dental implant surgery setting

OBJECTIVES: Dental implantation is a stressful experience, both physically and psychologically. The effect of anxiety on the patient's ability to process relevant information prior to a stressful clinical situation (implant insertion) was evaluated. MATERIALS AND METHODS: The study included 98 healthy patients, scheduled for implant insertion. Two different audio-tapes with relevant information regarding implant insertion were listened to immediately pre-operatively. Recognition questionnaires, consisting of 21 statements (correct and false information) were prepared, one for each tape. The dental anxiety scale (DAS), degree of state anxiety (SA), evaluation of pain expected during surgery, and extent to which patients understood the information provided were examined on 100 mm visual analogue scales. RESULTS: A significant positive correlation was found between patients' DAS and SA and between patients' expectation to experience pain during the surgical procedure. Certainty of understanding (CU) significantly contributed to the explanation of correctly classified statements (beta=-0.43, t=3.71, P<0.01). CU was positively related to SA and negatively to DAS. CONCLUSIONS: In a stressful pre-surgical situation, the ability to process relevant information may be severely impaired and should not be given to patients immediately before planned treatment.     

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牙颌面畸形正颌外科治疗需要根据畸形的情况、治疗的要求以及术前患者的生理、心理状态评估综合制定治疗方案.在术前必须对治疗方案、(牙合)关系的调整、骨切开的部位、骨段移动的方向和距离经过精确的设计.正颌外科的术前设计包括头影描迹设计、预测,计算机辅助设计以及模型外科等.本文结合笔者的临床经验和国内外文献对牙颌面畸形正颌外科治疗的术前设计进行述评,强调了牙颌面畸形正颌外科手术方案的设计原则,提出了计算机辅助外科在正颌外科领域具有显著的优势和广阔的应用前景.     

Dental hygienists''influence on the patients''knowledge, motivation, self-care, and perception of change

The purpose of this study was to assess the success of the dental hygienist in the dental health education of dental patients in general dental practice. Special emphasis was laid on health education in the field of periodontics. The answers on a questionnaire of 159 dental patients who visited a dental hygienist were compared with the answers of 302 dental patients who had never visited a dental hygienist. The comparison was done by means of t-test and regression analysis on specially developed scales with regard to knowledge, motivation, self-care, and perception of change. On all scales the dental patients who visited a dental hygienist scored better. This difference remained when social demographic variables and the dentist's influence were taken into account. This indicates that the dental hygienist is successful in the behavioral aspect of her work.     

Accuracy of perioperative mandibular positions in orthognathic surgery

Mandibular position is an important parameter used for the diagnosis of dentofacial deformities, as well as for orthognathic surgery planning and execution. Centric relation (anterior and superior relationship of the mandibular condyles interposed by the thinnest portion of their disks against the articular eminencies), centric occlusion (when lower teeth contact upper teeth at centric relation), and maximal intercuspation (complete interdigitation of lower and upper teeth) are not often addressed as factors that influence the results of orthognathic surgery, although these relationships are critical to ensure accuracy during the surgery. The present study assessed occlusal measurements taken before and after the induction of general anaesthesia from consecutive orthognathic surgery subjects. The variables assessed included the differences between these occlusal measurements, patient age, gender, type of deformity, and type of proposed orthognathic surgical procedure. The results demonstrated statistically significant differences for mandibular retrusion from maximal intercuspation to centric occlusion position, whereas the mandible appeared not to change significantly from centric occlusion after the induction of general anaesthesia. Patient age and the type of deformity appeared to influence the results. While in most instances centric occlusion can be adequately reproduced under general anaesthesia, for some specific orthognathic cases more accurate results might be obtained if the mandible-first sequence is used.     

Maxillary Sinusitis Caused by Dental Implants Extending into the Maxillary Sinus and the Nasal Cavities

This report describes the case of a patient who underwent osseointegrated dental implant placement. The implants were misplaced inside the nasal fossae and in the right maxillary sinus, causing chronic purulent sinusitis. CT scan without contrast showed signs of right maxillary sinusitis and confirmed the misplacement of four dental implants that surfaced into the nasal cavities. The imaging also revealed the presence of another implant that emerged inside the maxillary sinus. The patient underwent functional endoscopic sinus surgery with complete symptom remission at the long‐term follow‐up. We propose that sinusitis caused by protrusion of implants and by sinus floor lift procedures could share common physiopathological patterns and predisposing factors.     

牙种植外科技术探讨

牙种植外科技术是牙种植学的重要组成部分之一，它直接关系到牙种植的成功与失败。本文结合几年来的临床实践，介绍了牙种植患者的术前评估、治疗设计，重点对于该手术的外科手术问题进行探讨。文章还对该手术的注意事项，如何保证正确的种植部位与方向，防止副损伤等问题介绍了作者的体会。     

Multidisciplinary rehabilitation of eosinophilic granuloma with bone graft surgery and a modified implant‐supported hybrid prosthesis: A case report with a 6‐year follow‐up

Eosinophilic granuloma is the most common form of Langerhans cell histiocytosis and corresponds with bone lesions characterized by pain, rapid growth, and high tendency of recurrence after inadequate curettage. It is a rare disease that is difficult to diagnose clinically and radiographically because it mimics other odontogenic cysts and tumors. In this report, the reconstruction of an osseous defect with an iliac graft and a modified implant‐supported hybrid prosthesis after surgical excision of an eosinophilic granuloma in the mandible of a 27‐year‐old male patient was described. The patient was satisfied with the functional and esthetic results of the implant‐supported restoration and a 6‐year follow‐up showed no sign of recurrence.     

Implant dentistry in predoctoral education: The elective approach

In response to interest by dental students and patient needs, an elective program in implant dentistry was started at the University of Detroit Mercy School of Dentistry (UDM) in the summer of 1994. The 1-year program is offered to a group of 10 senior students out of a class of 72. Implant treatment is provided to selected edentulous and partially edentulous patients. Predoctoral students participate in diagnosis and treatment planning, assist in surgical placement, and perform the prosthodontic procedures. A survey was sent to 160 UDM graduates, and 90 responded. Out of the 90 respondents, 35% had participated in the elective implant program and 65% had not. A Pearson correlation matrix was used to analyze their responses. A stronger positive correlation with offering and restoring implants was seen in graduates who had completed the elective program in implant dentistry.     

Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork

Aim: The aim of this study was to describe the self‐reported confidence levels of final year students at the School of Dentistry, Cardiff University and at the University Dental School & Hospital, Cork, Ireland in performing a variety of dental procedures commonly completed in primary dental care settings. Method: A questionnaire was distributed to 61 final year students at Cardiff and 34 final year students at Cork. Information requested related to the respondents confidence in performing a variety of routine clinical tasks, using a five‐point scale (1 = very little confidence, 5 = very confident). Comparisons were made between the two schools, gender of the respondent, and whether or not a student intended completing a year of vocational training after graduation. Results: A response rate of 74% was achieved (n = 70). The greatest self‐reported confidence scores were for ‘scale and polish’ (4.61), fissure sealants (4.54) and delivery of oral hygiene instruction (4.51). Areas with the least confidence were placement of stainless steel crowns (2.83), vital tooth bleaching (2.39) and surgical extractions (2.26). Students at Cardiff were more confident than those at Cork in performing simple extractions (Cardiff: 4.31; Cork: 3.76) and surgical extractions (Cardiff: 2.61; Cork: 1.88), whilst students in Cork were more confident in caries diagnosis (Cork: 4.24; Cardiff: 3.89) fissure sealing (Cork: 4.76; Cardiff: 4.33) and placement of preventive resin restorations (Cork: 4.68; Cardiff: 4.22). Conclusion: Final year students at Cardiff and Cork were most confident in simpler procedures and procedures in which they had had most clinical experience. They were least confident in more complex procedures and procedures in which they had the least clinical experience. Increased clinical time in complex procedures may help in increasing final year students’ confidence in those areas.     

Report of recommendations from the National Dental Public Health Workshop, February 10-12, 2002, Bethesda, MD

A two-and-a-half day workshop was held beginning February 10, 2002, to review the current state of dental public health training in the United States with the aim of creating recommendations that would address identified problems and lead to improvements in the quality of dental public health training. This workshop, held in Bethesda, Maryland, was sponsored by the Health Resources and Services Administration (HRSA) through a contract with the American Association of Public Health Dentistry (AAPHD). Workshop invitees included the program directors of all accredited dental public health residency programs in the United States and Canada, selected dental public health residents, and additional consultants invited based on their expertise in dental public health education. The recommendations have been placed into three categories: training, financing, and workforce development. Along with background and process summaries, these recommendations are reported here.     

Dentistry's role in obstructive sleep apnoea. Review and case report

Obstructive sleep apnoea (OSA) has been associated with many life-threatening conditions but has only recently appeared in the dental literature. Dental appliances and orthognathic surgery are two strategies which are currently used in the treatment of sleep apnoea. This article provides a background on OSA and these treatment approaches, and discusses the potential risks and benefits of each. A case is reported to illustrate the use of a dental appliance in the treatment of OSA.     

骨性下颌前突术前正畸去代偿治疗效果的研究

目的　探讨术前去代偿在骨性下颌前突畸形矫治中的作用。方法　 18例已接受过正畸—外科联合治疗的骨性下颌前突患者 ,以X线头影测量方法对其术前正畸去代偿的前后结果进行研究。结果　在骨性下颌前突患者 ,普遍存在牙齿的代偿现象 ,牙代偿不仅存在于下颌 ,而且存在于上颌 ;并同时存在于前牙和后牙 ;去代偿后 ,上、下牙齿相对于基骨的位置得到了明显的改善。结论　术前去代偿为外科手术后退下颌骨至正常位置打下良好的基础。术前正畸去代偿 ,是治疗骨性下颌前突畸形的重要步骤。也是获得高质量手术结果的可靠保证