The bigger the better: can magnification aid orthodontic clinical practice?

The use of magnification in dentistry appears to be of increasing interest. This is also reflected in our own specialty, with a number of optical companies exhibiting their products at orthodontic conferences and meetings. This article reviews the principles of magnification, briefly discusses the magnification loupes that are available on the market at the present time, and highlights the advantages and disadvantages of using magnification for orthodontic treatment.     

Expansion: how much can the periodontium tolerate?

Arch length discrepancy can be resolved either by extraction or expansion. Normally, the choice of the clinician is founded on evidence-based treatment outcome reports. The adverse effect related to either approach is considered carefully before deciding. In the adult patient, the retraction of soft tissues consequent to extractions may be undesirable. Also, the deep bite may be difficult to correct if incisor proclination is to be avoided. Expansion has been reported to elicit gingival dehiscences. This is a report of a borderline case where the crowding is resolved acceptably through extreme expansion, but without any adverse periodontal effects.     

Is the Internet useful for clinical practice?

BACKGROUND: Internet use in dentistry is increasing. The authors surveyed dentists to determine how they are using the Internet to support patient care and how useful they perceive the Internet to be. MATERIALS AND METHODS: The authors sent a 25-question survey to 455 subscribers to the Internet Dental Forum, an Internet discussion list. Participants completed the survey through a Web page or by e-mail during an 18-day period in December 1998. The survey included questions about when they began using the Internet and their motivations for doing so, their positive and negative experiences, where they use the Internet and why, their use of information resources--including electronic information resources--and demographics. RESULTS: The authors received 314 surveys from 438 participants, a 72 percent response rate. Participants reported demographic characteristics similar to national averages and were highly computer-literate. Most considered the Internet essential for their practice and had increased their Internet use for professional reasons over time. Ninety-seven percent of respondents used the Internet at home, and 68 percent used it in the office. Only 5 percent used the Internet in the treatment area. The primary reason cited by participants for using the Internet was to keep up in general, followed by to answer patient-specific questions and to provide patient education. Reduction of professional isolation was one of the most frequently cited advantages of using the Internet. CONCLUSIONS: The authors found that some dentists use the Internet to support clinical practice and that it helped dentists adopt new techniques for patient treatment and obtain information on new materials or products. CLINICAL IMPLICATIONS: The Internet appears to support clinical practice mostly indirectly, by helping users keep up in general, rather than by answering specific clinical questions.     

A way of establishing the clinical practice guidelines for prosthodontics. What's the clinical practice guideline?

Clinical practice guidelines are the supporting tool for decision-making in medical and dental practice. It is a duty of the academic societies of medicine and dentistry, including Japan Prosthodontic Society, to establish and publish the evidence-based clinical practice guidelines. This article deals with the essential knowledge of the clinical practices guideline and the desirable methods of making the guideline for preparing the high-quality clinical practice guideline for prosthodontics.     

Occlusal splints and temporomandibular disorders: why, when, how?

Occlusal splints are one form of treatment in the management of patients with a temporomandibular disorder. Appliances are often used in conjunction with other forms of treatment such as physiotherapy or medication. A variety of splints is described in the literature and the dentist must ensure that the splint prescribed is of a design that has a proven success rate for the specific diagnosis. General principles that apply to the provision of all splints are outlined in this paper.     

Routine HIV testing in dental practice: can we cross the Rubicon?

The latest Centers for Disease Control and Prevention (CDC) guidelines recommend routine HIV screening for a large segment of the population, given that the individual understands that an HIV test will be performed unless he or she declines testing (opt-out testing). The CDC recommendation calls for the elimination of formalized requirements for written consent and pretest counseling to encourage more Americans to voluntarily accept testing. Knowledge of HIV infection can increase early access to care and treatment and reduce further transmission. A rapid non-invasive test for HIV infection (OraQuick Advance) from oral fluid has recently become available. It offers two distinct advantages: 1) results are available within twenty minutes, thereby eliminating a long waiting period; and 2) it has high sensitivity and specificity comparable to blood testing. A preliminary positive test result must be confirmed with a Western Blot by an outside laboratory or physician. Important ethical and legal issues must be resolved before the successful implementation of HIV testing in the dental setting. An educational emphasis on broader coverage of HIV testing is also needed within the dental school curriculum. The integration of HIV testing into dental practice is discussed as well. A policy of screening patients in dental offices will contribute to a major advance in public health.     

Occlusal registration: science or art?

Most of the information available to guide the clinician in making occlusal records focuses on the clinical techniques and methods involved. There is little objective information regarding the use of the more recently introduced elastomeric materials which are growing in popularity in the clinic. Much of the published work relies on the clinical experience of the authors rather than the properties of the material to be used to make the occlusal records. This paper aims to review the materials currently available to clinicians for use in occlusal registrations. The materials are discussed with regard to their suitability for the task and suggestions given regarding their use. Setting aside considerations of technique, it is suggested that there would be value in basing the selection of materials for occlusal registration on objective research. However, it may well be that the technique, as with many other things in dentistry, is as important as the specific properties of the materials used.     

Stress in dentistry: how can you C-O-N-T-R-O-L it?

Stress cannot be eliminated. The challenge and opportunity lies in the ability to control or manage your response to stress. Those who choose to control their stress by actively and constructively managing it can learn to turn its potentially harmful force into high-powered energy.     

Who can inspect your dental practice?

There are several government agencies that may inspect your dental practice. The majority of inspections are carried out by the National Employment Rights Authority, the Health and Safety Authority, the Revenue Commissioners and the Radiological Protection Institute of Ireland. Below is a summary of the minimum requirements that should be in place to ensure compliance with the relevant legislation. You should always seek appropriate advice for your own particular circumstances.     

The endangered clinical teacher scholar: will this eliminate discovery from the dental school environment?

Each year, dental schools struggle to do more with less-a reality that is confounded by dental faculty shortages and retention issues reported over the past 15 years. In today's academic environment, faculty shortages suggest that the resulting smaller faculty population will be tasked with more responsibilities than those who had the benefit of working with a full complement of colleagues. Fewer clinical faculty will likely participate in scholarly activity-in some instances, negatively affecting their chances for promotion and tenure, and ultimately lessening their own job security and feeling of accomplishment and self-worth in the academic environment. New faculty are in need of a formal program endorsed by their administration-one which places them with colleagues experienced in scholarly activity. This program, to include a definitive reward structure for mentors, would likely foster the retention and promotion of faculty and encourage the development of future leaders of dental education. Without a definitive plan, the clinical scholar will become an endangered species, and the research innovations and discovery of our profession will fall short in addressing the needs of the public's oral and systemic health.     

Patients are not equally susceptible to periodontitis: does this change dental practice and the dental curriculum?

In the 1960s and 1970s, data became available indicating that most of the adult population had periodontal disease and that effective bacterial removal prevented and treated periodontitis. This information led to a systematic approach to the management of periodontal disease and influenced teaching of periodontics in dental schools. We now know that most adults have only gingivitis and very mild localized periodontitis. A small percentage, albeit representing substantial numbers, of adults have generalized severe periodontitis. We also recognize that a few currently known and measurable risk factors, including diabetes, smoking, and genetics, can identify the patients who are at risk for the severe generalized cases that require extensive therapy and intensive prevention, as well as patients at risk for a less-predictable response to treatment. This review will discuss the evidence that supports the change in our knowledge and understanding of periodontal disease. The question now becomes at what point, and how, do we integrate this new knowledge into the dental curriculum?     

What drives the practice?

There are many opportunities to expand the role of the dental hygienist and provide patients with exceptional oral health care. The hygiene department has the potential to significantly increase production and profits. However, the proper business systems must be incorporated into the practice. Improving hygiene-department systems involves training hygienists to provide comprehensive care and new services to patients.     

Children's toothbrush contamination in day-care centers: how to solve this problem?

Objective

To evaluate the contamination level of toothbrushes by mutans streptococci (MS) and the efficacy of antimicrobial solutions: cetylpyridinium chloride 0.05 % (CPC; Cepacol?) and chlorhexidine 0.12 % (CHX; Periogard?), to disinfect toothbrushes of preschool-aged children in day-care centers.

Material and methods

Fifty-two children were randomly divided into three groups, and a three-stage changeover system was used with a 1-week interval between each stage. Solutions were used by a different group of children in each stage. Children were submitted to a 1 minute brushing without dentifrice, performed by a professional calibrated, followed by random spraying over the bristles of brushes. Process and microbiological analysis were realized, and four brushes of each group were analyzed by scanning electron microscopy (SEM).

Results

Friedman's test at 5 % significance level revealed difference between the antimicrobial solutions (p?Conclusions The toothbrushes were contaminated with MS after a single brushing.

Clinical relevance

Although CPC has shown good results in comparison with the control, CHX showed greater efficacy in disinfection bristles of toothbrushes.