Two-year Follow-up of 11,000 Dental Sealants in First Permanent Molars in the Saskatchewan Health Dental Plan

The follow-up study examines the clinical success of sealing pits and fissures of permanent molars in a large auxiliary-based children's dental care program. The success of sealant use after one and two years was assessed using the following independent variables, (1) total number of sealants, (2) tooth location, (3) age of patient, and (4) initial caries status. The computerized records of 4,525 patients with 11,237 sealants were analyzed using the Statistical Analysis System (SAS). Success occurred where no further treatment services were performed or where the tooth was resealed. The success rate after one year was 98.7 percent and after two years 97.0 percent. In considering tooth location, number of sealants per patient, age of patient, and initial caries status, the success rate varied only 2.2 percent over the two years.     

Considerations for the use of oral sedation in the institutionalized geriatric patient during dental interventions: a review of the literature

Some institutionalized elderly persons need a sedative prior to a dental examination or treatment because they have a disturbance due to physical illnesses, degenerative changes in the brain, and/or psychiatric disorders, associated with advanced aging. Oral administration is one of the safest methods of delivery of a sedative drug. It is almost universally acceptable, easy to administer, costs little, has a low incidence and severity of adverse reactions, and requires no additional formal specialized training for the dentist. However, theoretical and practical knowledge of sedation is essential. This paper reviews the literature on oral sedation for the geriatric patient. Benzodiazepines are most often used for oral sedation of geriatric patients. The properties of these drugs were reviewed, and recommendations were made with respect to the drugs of choice and their dosage. Generally, fast-acting benzodiazepines of short duration, with rapid rate of elimination and no active metabolites, are recommended. The drug of choice, and the dosage, may vary according to the medical history and physical condition of the patient.     

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers,Israel

Objectives

Dental caries is the most prevalent chronic disease in children. Caries risk assessment tools enable the dentists, physicians, and nondental health care providers to assess the individual's risk. Intervention by nurses in primary care settings can contribute to the establishment of oral health habits and prevention of dental disease. In Israel, Mother and Child Health Centers provide free preventive services for pregnant women and children by public health nurses.

Materials and Methods

A caries prevention program in health centers started in 2015. Nurses underwent special training regarding caries prevention. A customized Caries Risk Assessment tool and Prevention Protocol for nurses, based on the AAPD tool, was introduced. A two‐step evaluation was conducted which included a questionnaire and in‐depth phone interviews.

Results

Twenty‐eight (out of 46) health centers returned a completed questionnaire. Most nurses believed that oral health preventive services should be incorporated into their daily work. In the in‐depth phone interviews, nurses stated that the integration of the program into their busy daily schedule was realistic and appropriate. The lack of specific dental module for computer program was mentioned as an implementation difficulty.

Discussion

The wide use of our tool by nurses supports its simplicity and feasibility which enables quick calculation and informed decision making. The nurses readily embraced the tool and it became an integral part of their toolkit.

Conclusion

We provide public health nurses with a caries risk assessment tool and prevention protocol thus integrating oral health into general health of infants and toddlers.     

Academic Dental Public Health Diplomates: Their Distribution and Recommendations Concerning the Predoctoral Dental Public Health Faculty

Objectives : The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Methods : Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Results : Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Conclusion : Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.     

Salivary slgA and Cortisol: Markers for Functional Dependence in Older Adults

Elderly persons with health problems and physical limitations have reduced independence. Since poor functional ability is a known risk factor for disease among older populations, including oral disease, this study was undertaken to assess whether salivary defense factors and the stress hormone Cortisol are significant markers for functional dependence. Oral examinations; salivary and microbial analyses; and interviews using the Activities of Daily Living (ADD index, the Mini Nutritional Assessment (MNA) and the Perceived Life Stress Questionnaire (PLSQ) were conducted for 123 dentate subjects. Of the subjects. 80 lived independently in the community or in apartments at the Baycrest Centre for Geriatric Care in Toronto, Canada, and 43 resided in the Baycrest nursing home or the Baycrest Hospital. Whole saliva samples were assayed for total secretory immunoglobulin A (stgA), slgAI, slgA2, total protein and Cortisol using ELISA. Dependent residents in the nursing home/hospital scored significantly lower in the nutritional assessment, had higher mean PLSQ scores, increased total protein and Cortisol concentrations, and reduced salivary flow rates in comparison to ambulatory residents in the community/ apartments. In multivariate logistic regression, factors associated with functional dependence were: being male, perceiving income as inadequate, having low salivary flow rate and drinking less than 5 cups of water per day. These results indicate that salivary flow and Cortisol may be useful markers of functional dependence; however, the ability of these markers to predict functional decline cannot be confirmed until longitudinal studies are conducted.     

The use of vacuum-molded polyvinyl acetate-polyethylene copolymer (PVAC.PE) for a handicapped patient

This paper provides a survey of recent literature on the use of mouth sticks for patients who have little or no use of their limbs. Criteria for mouth stick design, types of appliances, and the fabrication of such devices are described. Details are given of a case of a young child with arthrogryposis multiplex congenita, in whom a novel approach was used to allow the safe intra-oral retention of writing implements     

A retrospective review of a service to provide comprehensive dental care under general anesthesia

Day-stay general anesthesia is indicated for a number of dental reasons, not least for those patients who are unable to accept routine dental care. Since 1979, the Dental Hospital of the University of Newcastle upon Tyne, UK, has provided a weekly day-stay service for the dental care of such patients. Reviews of this service were undertaken in 1983 and again in 1993. The latter study Investigated the provision of care for 265 patients and compared this with that for the 96 patients reviewed in the earlier study. This paper presents the results of the review and underlines the need for a very aggressive approach to preventive dental care for patients treated by this modality.     

Assessment of Oral Health–Related Quality of Life Before and After Third Molar Surgery

PURPOSE: This study was designed to further our understanding of recovery after third molar surgery by using 2 instruments to measure quality of life outcomes, the more global Oral Health Impact Profile (OHIP-14), and the condition-specific Health-Related Quality of Life (HRQOL) instrument. PATIENTS AND METHODS: Clinical and quality of life data pre- and postsurgery from 63 patients with all 4 third molars below the occlusal plane, treated with topical minocycline during third molar surgery to reduce the incidence of delayed clinical healing, were available for analyses. Each patient was given 2 questionnaires to complete; the more global OHIP-14 and the HRQOL instrument designed to assess recovery after third molar surgery. Prevalence, Extent, and Severity of the OHIP-14 scores were calculated presurgery and for postsurgery days (PSD) 1, 7, 14. The percentage of patients reporting clinically relevant responses detrimental to quality of life from the condition-specific HRQOL instrument were reported for the same time frame. RESULTS: Study patients were most likely female, less than 25 years old, and Caucasian. Most (72%) had bone removed from both lower third molars. Median surgery time was 27 minutes (interquartile range [IQ], 20, 40 minutes.). Median surgeons' estimate of overall difficulty was 14 of a possible 28 (IQ 10, 18), and the median degree of difficulty for lower third molars was 8 of 14 (IQ 6, 10). Few patients (only 10%) had delayed clinical healing. Prevalence for all OHIP-14 items, percent of patients reporting items "fairly often" or "very often," were increased from presurgery on PSD 1 and then decreased on PSD 7 and PSD 14. OHIP-14 Severity scores, the sum of OHIP-14 responses, followed the same pattern as the Prevalence scores. OHIP-14 Severity scores on PSD 1 were 27 (IQ 16, 34), decreasing to 8 (IQ 3, 13) by PSD 7, and 1 (IQ 0, 5) by PSD 14. Recovery for outcomes addressed by both instruments followed a similar pattern and time course. However, each instrument also assessed distinctly different outcomes, adding information that could not be obtained by 1 instrument alone. CONCLUSION: Complementary instruments to measure quality of life outcomes provide a broader understanding of recovery after third molar surgery.     

An Analysis of the Effect of a Vent Hole on Excess Cement Expressed at the Crown–Abutment Margin for Cement-Retained Implant Crowns

Purpose: The labial margins of anterior implant‐retained crowns are often positioned subgingivally for a superior esthetic appearance. One of the consequences of subgingival margins is the increased risk of leaving excess cement behind following cementation. This can lead to potential problems, including peri‐implant inflammation, soft tissue swelling, soreness, bleeding or suppuration on probing, and bone loss. The purpose of this laboratory study was to investigate the effect of placement, location, and diameter of a vent hole on the amount of cement being expressed at the margin of an anterior implant abutment‐retained crown. Materials and Methods: Three implant crown copings were fabricated to fit on the same custom abutment. Three vent diameters (0.75, 1.25, and 1.65 mm) and three locations on the palatal surface of the coping (cervico‐palatally, mid‐palatally, inciso‐palatally) were chosen for vent hole placement. For each test, the coping was cemented onto the abutment under standardized conditions. A preweighed thin coating of cement was applied to the fit surface of the coping. The amount of cement expressed at the margin and vent hole was measured by weight and calculated as a proportion of the amount of cement placed in the coping before seating. The procedure was completed 15 times for each variable. The results were statistically analyzed using univariate ANOVA with post hoc Bonferroni‐adjusted independent samples t‐tests. Results: The presence of a vent hole influenced the proportion of cement expressed at the coping margin (p < 0.05). The location of a vent hole influenced the proportion of cement expressed at the coping margin (p < 0.05), with the exception of the mid‐palatal and inciso‐palatal positioning where there was no significant difference (p= 0.61) between groups. The diameter of the vent hole did not significantly influence the proportion of cement expressed at the coping margin (p= 0.096). Conclusions: When using anterior cement‐retained implant crowns, the use of a 0.75‐mm mid‐palatal or inciso‐palatal vent hole to minimize the amount of cement expressed at the margin during cementation should be considered.