A comparison of costs in providing dental care for special needs patients under sedation or general anaesthesia in the North East of England.

OBJECTIVE: To compare the costs of providing dental treatment under general anaesthesia or sedation for special needs patients. METHODS: After a Delphi exercise, a questionnaire was designed, piloted and then sent to nine NHS Trust dental service managers, within the Salaried Dental Services in the North East of England, to obtain information on the costs incurred during the treatment of special needs patients using sedation or general anaesthesia. The questionnaire related to the average number of such patients treated per session, staff costs, depreciation cost for buildings and equipment, and overhead costs including consumables and drugs. RESULTS: All nine dental service managers returned completed questionnaires. The all-inclusive cost for treatment per patient under general anaesthesia ranged from 203.65-479.50 pounds (mean cost: 285.79 pounds) and for sedation from 57.60-153.50 pounds (mean cost: 90.81 pounds). On average three special needs patients were treated per session. The greatest variation in the costs for general anaesthesia was due to staffing costs, which ranged from 1064.10 to 350.00 pounds per session across the Trusts. CONCLUSIONS: In the small number of centres sampled, the cost of delivering dental care under sedation or general anaesthesia was shown to vary widely. Overall, the mean cost of sedation was one-third that of general anaesthesia. However, the cost of both was substantial and cognisance needs to be taken of the costs of such services.     

Partial caries removal and cariostatic materials in carious primary molar teeth: a randomised controlled clinical trial

OBJECTIVE: To determine the durability and effectiveness of a black copper cement (BCC) and a conventional glass ionomer cement (GIC) when used to restore primary molars following partial caries removal (PCR) and to compare these results with conventional cavity preparation and restoration. DESIGN: Split-mouth randomised controlled clinical trial. SETTING: Department of Paediatric Dentistry, Dundee Dental Hospital, Dundee, 1998-1999. SUBJECTS: Patients with previously unrestored, matched carious cavities in non-pulpally involved primary molars. INTERVENTIONS: Three treatment groups: (1) Partial caries removal followed by lining with BCC and restoration with GIC (PCR:BCC); (2) Partial caries removal and restoration with GIC alone (PCR:GIC), and (3) Complete caries removal and conventional restoration (CR). Restoration durability and effectiveness was assessed both clinically and radiographically over 24 months.Main outcome measures Median survival time (MST) of restorations. RESULTS: Forty-four patients (F: 31; M: 13), mean age 6.8 years (range: 3.7-9.5), had 120 restorations placed (PCR:GIC: 43; CR: 41; PCR:BCC: 36). Eighty-six molars (29 patients) (PCR:GIC: 30; CR: 29; PCR:BCC: 27) were reviewed at 24 months. The median survival times (MST) with 25% and 75% quartiles in parenthesis were as follows: PCR:BCC, MST = 24 months (6, 24); PCR:GIC, MST = 24 months (24, 24) and CR, MST = 24 months (24, 24). The MST for PCR:BCC restorations was significantly less than for PCR:GIC and CR restorations (W = 1163.5, P = 0.028 and W = 1081.0, P = 0.004 respectively). CONCLUSION: There were no differences in the proportions of restorations lost between restoration types, although PCR:BCC restorations did have significantly more abscess/sinus formation over the 24-month study period.     

Multi-center clinical comparison of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) and ABM in human periodontal osseous defects. 6-month results

BACKGROUND: Intraosseous periodontal defects present a particular treatment problem. New bone replacement grafts offer promise for improved results. METHODS: The role of a synthetic cell-binding peptide (P-15), combined with anorganic [corrected] bovine-derived hydroxyapatite bone matrix (ABM), was compared to ABM alone in human periodontal osseous defects in a controlled, monitored, multi-center trial. Following appropriate initial preparation procedures, flap surgery with defect and root debridement was performed. Two osseous defects per patient were treated randomly with each procedure after surgical preparation. Appropriate periodontal maintenance schedules were followed, and at 6 to 7 months, re-entry flap surgery was performed for documentation and finalization of treatment. RESULTS: T test and Mann-Whitney U analyses of patient mean values from 33 patients revealed that the combination ABM/P-15 grafts demonstrated significantly better mean defect fill of 2.9 +/- 1.2 mm (72.9%) versus a mean defect fill of 2.2 +/- 1.4 mm (50.67%) for defects treated with ABM (P<0.05). Other hard tissue findings showed similar clinically superior results with the use of ABM/P-15. Relative defect fill results showed 81% positive (50% to 100% defect fill) responses with ABM/P-15 and 67% positive responses with ABM. There were 3.5 times as many optimal results (> or = 90% defect fill) with ABM/P-15 and twice as many failures (minimal response) with ABM. Soft tissue findings showed no significant differences between treatments. CONCLUSIONS: These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than the ABM alone in intrabony periodontal defects.     

Accumulation of methotrexate polyglutamates in lymphoblasts is a determinant of antileukemic effects in vivo. A rationale for high-dose methotrexate.

Methotrexate (MTX) is one of the most widely used drugs for the treatment of childhood acute lymphoblastic leukemia (ALL) and is commonly given in high doses. However, the rationale for high-dose MTX (HDMTX) has been challenged recently. To determine whether higher MTX polyglutamate (MTXPG) concentrations in ALL blasts translate into greater antileukemic effects, 150 children with newly diagnosed ALL were randomized to initial treatment with either HDMTX (1,000 mg/m2 intravenously over 24 h) or lower-dose MTX (30 mg/m2 by mouth every 6 h x 6). ALL blasts accumulated higher concentrations of MTXPG and long-chain MTXPG (MTXPGLC) after HDMTX (P < 0.00001). Of 101 patients evaluable for peripheral blast cytoreduction, MTXPG concentrations were higher in patients whose blast count decreased within 24 h (P = 0.005) and in those who had no detectable circulating blasts within 4 days (P = 0.004). The extent of inhibition of de novo purine synthesis in ALL blasts was significantly related to the blast concentration of MTXPGLC (IC95% = 483 pmol/10(9) blasts). The percentage of patients with 44-h MTXPGLC exceeding the IC95% was greater after HDMTX (81%) than LDMTX (46%, P < 0.0001). These data indicate that higher blast concentrations of MTXPG are associated with greater antileukemic effects, establishing a strong rationale for HD-MTX in the treatment of childhood ALL.