Examiner variability in the assessment of dental restorations

A series of examiner variability studies were carried out in the assessment of restorations in adults made by extended duty ancillaries (E.D.A.s). While there were some differences between the two supervising team dentists these were smaller than those found when dentists who did not work in the project were examined. The use of indirect evaluation by examining bitewing radiographs for the presence of overhangs was no improvement over the clinical examination in terms of examiner agreement, and moreover only identified half of the restorations scheduled for replacement clinically. Using the results of these experiments, it is suggested that quality control should take into account examiner variability and consequently a 3-4% sample would be sufficient to maintain standards.     

Dental hygienists as a new element in the oral health service in Poland

A comparison of the number, employment, utilization and activities of dental hygienists in Poland between 1977 and 1982 is described. In spite of a distinct increase in number and better distribution in the country, the employment of hygienists in the oral health service is still low. However, the majority of dental hygienists are employed in the oral health service for children, working mostly as dental assistants doing fluoride prophylaxis and dental health education in addition. The percentage of operating dental hygienists is also low. The need for their preventive activity is great, as the dental caries rate in Polish children is generally high.     

Changes of dental treatment pattern in Norway in the 1970s

With the aim of gauging utilization rates of dental services, a series of cross-sectional studies were performed in 1973, 1975 adnd 1977. Cluster samples of 1,600 individuals covering the Norwegian population aged 15 and above were interviewed by trained interviewers using standardized questions. The percentage of respondents who reported having seen a dentist within the last 12 months increased from 58 to 64. The receipt of tooth fillings was the predominant course of treatment and was reported by 55% of the interviewees. The percentage reporting preventive services increased from 15 to 26% at the expense of those reporting "blood and vulcanite" denistry. Fifty-two percent, increasing to 53% of the interviewers, claimed to have seen a dentist on a regular basis during the last 5 years. However, this proportion was conceivably overreported. Control questions indicated that 40-45% should be considered regular treatment attenders. Change is apparently taking place in the treatment pattern. The proportion of regular treatment attenders seems to increase by 0.5-1% per year. The treatment profile is also shifting: extractions and denture services are diminishing, preventive services are gaining, while restorative dentistry stands still - for the time being.     

Dental caries and dental treatment in the primary dentition in an industrialized South African community

This paper reports an examination of dental caries in the primary dentition of 2-5-yr-old white children in an industrialized South African city, in 1981 and 1983. There was a decrease in dental caries prevalence over the 2-yr period accompanied by an increase in dental treatment in 3-5-yr-olds. Treatment, however, remains low. Socioeconomic status had a varying effect on the trends, but in general there was a greater reduction in dental caries in the lower socioeconomic areas.     

Evaluation of the Accuracy of Solid Implant Casts

Purpose Materials used to fabricate the most dimensionally accurate implant casts have not been identified experimentally. The purpose of this investigation was to examine the dimensional accuracy of implant casts fabricated with different materials. Measurements of linear horizontal dimensional change and strain produced on a master framework were evaluated and correlated. Materials and Methods A master framework was fabricated to fit an aluminum five-implant model. Forty polyether implant impressions of the aluminum model were randomly grouped and poured in either Vel-mix, Die Keen, Resin Rock, or Low Fusing Alloy. A digital veneer caliper was used to measure linear distance between the most distal abutments on each of the experimental implant casts and the master model. In addition, strain values were recorded from strain gauges bonded in the mesiodistal axis of the framework, which was secured by prosthetic retaining screws torqued to 10 Ncm. Results A one-way ANOVA showed a significant difference among the four die materials in dimensional change of the experimental casts (p= .0001). A post-hoc Duncan's multiple-range test (p < .05) showed that casts fabricated with Low Fusing Alloy had the least linear dimensional change from the master cast, but the material exhibited the greatest dimensional variability. A MANOVA (Wilks' Lambda) showed significant differences in strain on the framework based upon die material (p= .015). A post-hoc Duncan's multiple-range test (p < .05) showed that Resin Rock casts induced significantly less strain on the framework than the other materials. Negligible correlation was found between the linear horizontal dimensional change and the total absolute strain on the framework. Conclusion Experimental implant casts made of Resin Rock minimized strain on the master framework and decreased the amount of framework distortion on casts of this material. Low Fusing Alloy yielded accurate casts, but highly variable linear dimensional changes in the horizontal dimension may preclude its clinical benefit.     

Evaluation of the Effects of Buccal–Palatal Bone Width on the Incidence and Height of the Interproximal Papilla Between Adjacent Implants in Esthetic Areas

Background: The presence of interproximal papilla depends on the distance between the contact point to the bone crest, as well as the mesio‐distal distance between implants or between implants and teeth. The aim of this study is to evaluate the effects of buccal–palatal bone width on the presence of the interproximal papilla between adjacent implants in esthetic areas of the mouth. Methods: The presence or absence of the gingival papilla, distance from the base of the interproximal contact to the tip of the gingival papilla (black space), distance from the base of the interproximal contact to the alveolar crest (vertical distance), alveolar bone width (bone width) between adjacent implants as well as the spacing between the implants (horizontal distance), and soft‐tissue biotype were assessed in 29 interimplant areas in the upper incisor, canine, and premolar regions of 18 patients. Results: The papilla was always present when vertical distance was ≤5 mm (P ≤0.04) and frequently present when the horizontal distance was ≥4 mm (P = 0.04). The black space was smaller when the vertical distance was ≤5 mm (P ≤0.04) and when the horizontal distance was ≥4 mm (P = 0.76). Bone width and soft‐tissue biotype did not influence the incidence of gingival papilla (P ≥0.41) and black space (P ≥0.15). Conclusion: Within the limits of this study, it can be concluded that bone width and tissue biotype do not have an effect on the incidence and height of papilla between adjacent implants in esthetic areas, and the incidence was greater when vertical distance was ≤5 mm or when horizontal distance was ≥4 mm.     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

Investigation into the relationship between deviations in X-ray angulation and images of proximal overlapping on bite-wing radiographs

Abstract Eleven child skulls were radiographed through a range of 50 degrees by varying the horizontal angulation of the X-ray beam in steps of 2 or 5 degrees. The changes in the width of overlapping contact images and the ranges through which no overlap occurred were measured. A linear relationship between changes in X-ray beam angulation and overlap width was found in all the skulls. Using the data it was calculated that for each increase in overlap width of 0.1 mm, 95% of the deviations in X-ray beam angulation were less than 2.5 degrees. The findings of this study suggested that the positioning of the X-ray beam so as to cause no overlapping is at best difficult, and at worst impossible. They also emphasize the importance of using identical projections in estimating the progress of carious lesions on radiographs since small changes can cause overlaps. The use of methods that reduce the error in repositioning the X-ray beam may be important in reducing methodological errors in clinical research.     

An assessment of the dental public health infrastructure in the United States

OBJECTIVES: The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level. METHODS: Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information. RESULTS: In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards. CONCLUSIONS: Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners.     

Sulfated glycoproteins in the acquired pellicle and in plaque from Macaca fascicularis demonstrated with labeled sulfate

abstract – A sulfated glycoprotein was demonstrated in 2-h pellicle material collected from monkeys. Furthermore, a sulfated macromolecule present in plaque extracts was identified as a sulfate glycoprotein by electrophoresis on cellulose acetate strips. The present data indicate that acidic proteins are selectively adsorbed to tooth surfaces in. vivo .     

On the solubility of zinc in the γ-phase of the silver-mercury system

abstract – By measuring lattice constants of a number of Ag-Hg-Zn alloys with γ-phase structure, it has been shown that apart from a possible two-phase field there exists a continuous solid solùtion between γ(Ag-Hg) and γ(Ag-Zn). A correlation between the Zn-content in the γ₁ phase in set dental silver amalgam and the Zn-content in the corresponding alloy has been determined.     

Effectiveness of the school dental screening programme in stimulating dental attendance for children in need of treatment in Northern Ireland

The school dental screening programme has been in existence from the beginning of the 20th century yet its value in encouraging attendance among children with a dental health need is not fully established. OBJECTIVE: To evaluate the effectiveness of school dental screening in promoting dental attendance among children with a treatment need and to examine the relative importance of screening, social class and other factors in dental attendance. METHODS: Sixty-four participating schools were assigned to study and control groups using a stratified, blocked randomisation technique. The study group children received the standard school dental screening and the dental attendance of those with a positive screening result was assessed after 2 months by means of a questionnaire issued to the children's parents. The control group children were not, at this stage, screened, yet their parents received the same questionnaire assessing dental attendance over the 2-month period. However, only questionnaires from control group children who had a positive result at a subsequent screening were retained for analysis. RESULTS: A total of 2,321 children were screened, with 980 having a positive result. The mean dmft of those screening positive was 4.85. In all, 664 completed questionnaires were returned, giving a response rate of 67.8%. Dental attendance was reported among 45.5% of the study group (n=352) in the 2 months following screening. In the same period, 27.6% of the control group (n=312) claimed attendance. The effect was found to be significant among the high employed group (P<0.01) and the unemployed group (P<0.05). CONCLUSION: School dental screening was capable of stimulating dental attendance. The strong effect among the lowest socio-economic group shows that school dental screening may be used to decrease dental health inequalities.     

A survey of the dental needs of hospital inpatients in Scotland

Eight hundred and ninety-four inpatients in four hospitals in Edinburgh were assta were used to estimate future inpatients' dental requirements and the hospital dental services which would be necessary to meet these needs. Seventeen percent of the sample was found to be suffering from pain or discomfort of dental origin and over 30% were considered to require some form of dental treatment before their expected date of inpatient discharge.     

Factors Influencing the Amount and Type of Dental Services Received by Older Adults in Four Municipalities in Ontario, Canada

Objectives : The purpose of this study was to investigate the factors influencing the pattern (amount and types) of dental care provided to dental visitors participating in the baseline stage of the Ontario Study of the Oral Health of Older Adults. Methods : We interviewed and examined older adults from four municipalities in Ontario and obtained dental service records for the previous two years for those reporting a dental visit. Individual services and their corresponding time and values were aggregated into categories. We compared the pattern of care for dentate and edentulous subjects, and by age, municipality of residence, and social, demographic and economic characteristics. Results : The 473 subjects received 5,031 services, more than four hours of dental care per subject over the two years. The 29 edentulous subjects received about one-third the number of services compared with the dentate; however, there were no differences in relative time units (RTUs) or relative value units (RVUs). Among the dentate the amount of care (RVUs) varied by municipality of residence and by visiting behavior, but not by age, income, or other socioeconomic variables. Conclusion : Both dentate and edentulous visitors received over two hours of care per person per year. Dental care patterns were influenced by dental status, area of residence, and visiting behaviors.     

Lay knowledge of physical education teachers about the emergency management of dental trauma in Hong Kong

Abstract – The purpose of this study was to investigate the knowledge of a group of physical education (PE) teachers about the emergency management of dental trauma in Hong Kong. A postal questionnaire was sent to PE teachers in 100 randomly selected secondary schools in Hong Kong. A total of 166 teachers from 65 schools responded. Results show that a majority of the respondents have received formal teaching training (98.8%). While all but one teacher had received formal first aid training, only eight of them recalled that they had received advice on the management of dental trauma. Concerning the management of tooth fracture, 118 respondents (71.1%) gave an appropriate answer. In contrast, only 29 teachers (17.5%) were able to indicate the appropriate management for an avulsed tooth. Over 60% (102) of the respondents indicated it was "very urgent" to seek professional assistance if a permanent tooth has been avulsed, but they had little knowledge of the correct procedures for replanting or transporting avulsed teeth. Only 15 respondents (9%) pointed out that milk was the medium of choice for transporting avulsed teeth. Finally, over 90% (157) of respondents indicated that they had never received advice on the emergency procedures for the management of dental avulsion. The present study showed that the level of lay knowledge of management of dental injuries in a selection of PE teachers in Hong Kong is inadequate and educational campaigns are necessary to improve their emergency management of dental injuries.     

串珠素在牙囊发育过程中的表达和意义

目的:观察牙囊发育不同时期串珠素(perlecan)分布、表达情况,探讨其与牙囊发育的关系。方法:出生0 d、1 d、1周、2周的SD大鼠取下颌第一磨牙及其牙囊组织,进行Perlecan免疫组化染色(SABC法),光镜观察其表达、分布,用图像分析测定其灰度值,并进行定量分析比较。结果:串珠素在各时间段牙囊均有阳性表达,而1 d、1周组表现为强阳性。图像分析结果表明1 d组、1周组大鼠阳性结果明显高于0 d组、2周组,出生后串珠素表达随着牙胚发育而不断增强,之后又随着牙胚的成熟而下降。结论:串珠素与牙囊的发育有关,在牙囊发育初期对牙囊基质的形成发挥作用,晚期随着基质的成熟其表达下降。     

Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful dental patient

The prevalence of dental anxiety in the general population seems to be fairly stable, and the incidence is not reduced in spite of more modern treatment methods. Intensive fear often leads to avoidance of care and consequences like poor oral health, psychosocial problems and reduced quality of life. The aetiology of dental anxiety is complex, but is often associated with direct traumatic dental experiences during childhood. These negative experiences are reported as painful/unpleasant and are influenced by the patient's perception of lack of coping and control. The theory of latent inhibition indicates that several positive dental appointments before any invasive or painful treatment sessions may act as a barrier to these perceptions of lack of coping. This paper is presenting a short overview of behavioural science in dentistry and discussing the role of the dental hygienists as potential key personnel in prevention and treatment of dental anxiety.