Colorado pit and fissure sealant survey: attitudes toward and use of pit and fissure sealants by Colorado general dentists

The purpose of this study was to conduct a survey of Colorado general dentists regarding the use of and attitudes toward pit and fissure sealants. The survey consisted of a questionnaire to determine the utilization levels of sealants by general dentists, reasons for limited placement or non-utilization of sealants, whether sealant placement was delegated to dental auxiliaries or not, and if continuing education courses on sealants had been attended by the dentists and/or their dental auxiliaries. A total of 544 completed questionnaires were available for study. The results indicated that sealants were used by 82.7% of the dentists. Approximately 70% of the practitioners reported that they utilized sealants either routinely or occasionally. Reasons for limited placement or non-utilization of sealants were, in descending order: 1) Not covered by insurance; 2) Inadvertent sealing in of caries; 3) Sealants do not last; 4) Sealants too expensive; 5) Not familiar with sealant technique; 6) Sealants not effective. Placement of sealants was delegated as follows: 1) Dentists, 64.8%; 2) Hygienists, 17.8%; 3) Assistants, 17.4%. Continuing education courses had been attended by 29.1% of the dentists surveyed. Only 6.6% of the dentists indicated that their staff had attended continuing education courses on sealant placement. A relatively high percentage of Colorado dentists are utilizing sealants on a frequent basis. Major reasons for limited usage or non-utilization of sealants relates to lack of insurance coverage and concern regarding sealing in of caries. A need for continuing education courses on sealants appears to exist.     

Infection control in general dental practice

A postal survey of 600 dental practitioners in New South Wales was conducted in 1986 to establish a data base on current infection control protocols as they apply to everyday dental practice. Three hundred and sixty-three replies (60 per cent) were returned, representing approximately 16 per cent of Australian Dental Association members in New South Wales (1987).     

Kinetics of acquisition and loss of calcium fluoride by enamel in vivo

Two in vivo experiments were performed, concerning (1) the kinetics of the acquisition of calcium fluoride on enamel during daily rinses with a solution of 0.023% F as sodium fluoride, and (2) the loss of calcium fluoride from enamel slabs which had been topically treated with a neutral solution containing 0.9% F as sodium fluoride. Enamel slabs were carried in the mouth by 6 volunteers for 8 days in both experiments. Sound and etched enamel were included. (1) During mouthrinses moderate amounts of fluoride were acquired by sound enamel, and more as calcium fluoride than as fluoridated apatite, whereas on etched enamel, more fluoride was deposited as fluoridated apatite. On etched enamel there was also a tendency that the deposition of calcium fluoride levelled out whereas the incorporation of firmly bound fluoride continued. This may indicate that calcium fluoride was transformed into fluoridated apatite, probably through remineralization during pH cycling in plaque covering the etched enamel. (2) After single topical application, it was found that etched enamel initially took up more calcium fluoride than sound enamel, but also lost more during the 1st day of in vivo exposure. The loss of calcium fluoride was arrested after 1-2 days, on sound enamel at 70% and on etched enamel at 40% of the original level. It is suggested that the increased amounts of firmly incorporated fluoride in enamel originated from calcium fluoride on enamel, and that calcium fluoride is an important and clinically significant source of fluoride ions on enamel.     

The elimination of cross-infection in dental practice--a 5-year follow-up

A survey in 1983 showed that 16% of general dental practitioners in the Lothian Region wore operating gloves when treating patients; 9% wore them continually and 7% only when performing dento-alveolar surgery. Twelve per cent replied that they would not consider wearing operating gloves and 72% stated that they might consider their use. A similar survey has now been completed 5 years later, involving practitioners in the Lothian and Borders regions. This shows that 163 (97%) of the 168 practitioners who replied now wear operating gloves; 51% restrict their use to the treatment of 'potentially infectious patients' and dento-alveolar surgery; 46% wear them continually. The main objections given to wearing gloves continually were loss of tactile sensation (67%) and cost (13%). The most difficult task to perform wearing gloves was root canal therapy (56%). The majority of practitioners (84%) believed that gloves reduced the dangers of cross-infection. The methods stated to be available for instrument sterilisation in 99.5% of practices were acceptable. This paper proposes that to eliminate cross-infection and protect the dental practitioner, operating gloves should be worn when treating all patients.     

Microbiological and immunological studies of adult periodontitis in patients with noninsulin-dependent diabetes mellitus

The subgingival microflora and serum antibody response was examined in periodontitis patients with noninsulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). The predominant cultivable microflora was determined for subgingival plaque sampled from two deep periodontal pockets in each of eight adult periodontitis patients with NIDDM. Indirect immunofluorescence for Bacteroides intermedius, Bacteroides gingivalis, and Haemophilus actinomycetemcomitans was used to examine these same samples as well as 186 additional subgingival plaque samples from 47 patients with moderate to severe generalized periodontitis including 25 subjects with NIDDM, six subjects with IGT, and 16 subjects with NGT. Serum antibody levels to 13 microorganisms including seven oral bacterial species and one nonoral control species were measured by enzyme-linked immunosorbent assays (ELISA) in 377 subjects including 84 normal subjects without periodontal disease, 112 normal subjects with periodontitis, 19 periodontally normal subjects with IGT, 65 periodontitis patients with IGT, 15 periodontally normal subjects with NIDDM, and 82 periodontitis patients with NIDDM. Three hundred eighty-two bacterial isolates were recovered from the eight patients. B. intermedius was the most frequently isolated microorganism constituting 16% of the total isolates followed by Wolinella recta and B. gingivalis, which each accounted for 13% of the total. Streptococcus sanguis was the most prevalent microorganism, which was found in 75% of the sites. Subgingival plaque samples examined by immunofluorescence demonstrate a high prevalence of black-pigmented Bacteroides and suggest that the proportion of B. gingivalis but not B. intermedius is higher in NIDDM with periodontitis than in other groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Co-ordinated treatment of secondary cleft deformities

Secondary cleft deformities result from the cumulative effects of functional and morphological abnormalities. Treatment choices should be based on a comprehensive plan which is designed to minimize treatment time and iatrogenic effects and which is based on sound physical and psychosocial objectives. Conventional orthodontic and orthognathic surgical principles can be modified and applied to a variety of facial cleft problems. Direct surgical correction of secondary deformities instead of prosthetic or orthodontic compensation expands treatment possibilities and optimizes treatment results.     

Acquisition of alkali-soluble fluoride by enamel through treatment with NaF-containing toothpastes in vitro.

The first aim of the present study was to examine if alkali-soluble fluoride (calcium fluoride-like material and adsorbed fluoride) forms when a NaF-containing toothpaste is applied on human enamel surface in vitro. The centrifuged supernatants of toothpastes dissolved in distilled water were used and four different commercial NaF-containing toothpastes were tested. The second aim was to investigate if pyrophosphate would interfere with the deposition of alkali soluble fluoride. The formation of alkali-soluble fluoride was determined by chemical analysis and visualized by scanning electron microscopy (SEM). It was ascertained that all tested toothpastes contained free fluoride according to the manufacturers' specifications. It was shown that they promoted deposition of alkali soluble fluoride on the enamel surface. The amount of deposited material increased with the time of exposure. The clinical effect of a NaF-containing toothpaste may thus well depend on an initial formation of alkali-soluble fluoride. Fluoride from this reservoir may adsorb onto the enamel crystals and inhibit further demineralization or increase the rate of remineralization during cariogenic challenges. It was also demonstrated that pyrophosphate did not interfere with the deposition of alkali soluble fluoride.     

Shear bond strengths of resin adhesive cements to dentin and Ni-Cr-Be alloy.

Two adhesives, Super Bond and Panavia, were evaluated for shear bond strength to dentin. Twenty human teeth were used for each adhesive. Bonding sites were prepared in dentin (600 grit) and the adhesives applied according to the manufacturers' instructions. Bond strengths were determined with an Instron testing machine at 24 hours. Super Bond developed the strongest bond of 21.59 +/- 3.91 MPa. Panavia produced a lower bond strength of 2.68 +/- 1.45 MPa. Statistically, Super Bond was found to have a stronger bond than Panavia. The same two adhesives were applied to Ni-Cr-Be specimens and compared to Comspan. Twenty Rexillium III specimens were used for each adhesive at 24 hours and 20 for thermocycling. The metal specimens were ground flat (600 grit) and then air abraded with 50-micron aluminous oxide. The adhesives were applied to the metal surface in accordance with the manufacturers' instructions. One group was tested at 24 hours while the second group was tested after thermocycling (2,500 cycles at 6 degrees C to 60 degrees C). At 24 hours, Super Bond had a significantly stronger bond than the other materials. Comparison of the 24-hour to thermocycled bond strengths found Comspan had a significant increase in bond strength, Panavia had no significant change and Super Bond had a significant decrease in bond strength. After 2,500 thermocycles, Comspan, Panavia, and Super Bond were not significantly different in bond strength.     

Prostaglandin E2 and interleukin-1 levels in smokeless tobacco-induced oral mucosal lesions

Inflammatory mediators released as a result of smokeless tobacco (ST)-induced irritation may play a role in the development of oral mucosal lesions at habitual tobacco placement sites in ST users. The present study examined levels of interleukin-1 (IL-1) and prostaglandin E2 (PGE2) in ST-induced mucosal lesions and compared these to mediator levels in clinically normal mucosa. Soft tissue biopsies were obtained from white mucosal lesions at habitual placement sites and normal alveolar mucosal tissue at non-placement sites in 18 ST users. Fifteen non-tobacco using subjects also provided normal alveolar mucosal biopsies. IL-1 and PGE2 were recovered from the specimens, and mediator levels were determined by enzyme immunoassay. Prostaglandin E2 levels (pg/mg) were lower in both regions in the ST subjects, but values did not vary significantly between the regions with 2.77±0.72 and 2.86±0.99 at placement and non-placement sites, respectively, in ST users and 7.31±3.84 in non-tobacco users. Both IL-1α and IL-lβ (pg/mg) were significantly (p < 0.0I) elevated in ST lesions (IL-lã=25.56±4.00; IL-1β=7.76±1.68) compared to either non-placement sites in ST users (IL-lα=14.64±2.65; IL-lβ=1.63±0.72) or non-tobacco users (IL-lα=12.84±2.60; IL-lβ=2.04±0.75). In view of IL-l's role in keratinocyte proliferation and its inflammatory effects, this cytokine may contribute to mucosal and gingival alterations observed in ST users.