Preventive Control of AIDS by the Dental Profession: A Survey of Practices in a Large Urban Area

The purpose of this study was threefold: (1) to report the proportion of dental practitioners adhering to the 1987 Centers for Disease Control (CDC) procedures for using infection control techniques (ICTs); (2) to identify attitudes toward infection control and disease; and (3) to establish whether certain practitioner characteristics or use of certain ICTs were related to willingness to treat HIV-positive patients, willingness to volunteer for an HIV specialty clinic outside of regular practice, vaccination against hepatitis B, and a felt need for a specialty clinic within the practice to treat HIV patients effectively. A survey of approximately 3,800 members of a major metropolitan dental society found that 89 percent of respondents regularly used at least one CDC ICT beyond routine medical histories. Ninety-one percent indicated a moderate to extreme change in attitude toward the risks of infectious diseases and the regular use of ICTs (80.2% identified AIDS as the major factor in this change). Twenty-seven percent indicated that they would knowingly treat HIV-positive patients. No differences were found among practitioners willing to treat HIV-infected patients and those unwilling to treat these patients in terms of adherence to the CDC ICT recommendations for dentists. Statistical association between ICT use and other practitioner response variables are discussed.     

Effect of pH on element release from dental casting alloys

Statement of problem. Dental casting alloys are subjected to transient acidity in the oral environment, yet most studies have not investigated the effects of these transient environments on elemental release from alloys. Elemental release is important because it plays a significant role in alloy biocompatibility. Purpose. It was hypothesized that acidic environments would increase elemental release from dental alloys during exposure and after the acidic environment was removed. This hypothesis was based on the known increase in release of nickel from nickel-based alloys in an acidic environment. Material and methods. High-noble, noble, and base metal casting alloys were exposed for 30 minutes to solutions with pH ranging from 1 to 7. Elemental release of representative elements was measured by means of atomic absorption spectrometry during the exposure and in the week after the exposure. This release was compared with elemental release in the week before the exposure. Results. High-noble and noble alloys were resistant to acidic environments. A pH of 4 did not increase elemental release during or after exposure. A pH 1 environment slightly elevated release of Ag, Cu, and Pd in some alloys. However, a Ni-based alloy released large amounts of Ni during the acidic exposure of pH 1 or 4, and more importantly, in the week after the exposure as well. Increased time of exposure to acid did not alter elemental release from noble or high-noble alloys, but markedly increased release from the Ni-based alloy. Conclusions. Transient exposure of casting alloys to an acidic oral environment is likely to significantly increase elemental release from Ni-based alloys, but not from high-noble or noble alloys. (J Prosthet Dent 1998;80:691-8.)     

Microleakage Evaluation in Amalgam Restorations Used with Bases

Marginal leakage in amalgam restorations often precedes the development of secondary caries. One potential way to improve the marginal seal of such restorations, and thus minimize the risk of carles development, is to apply a glassionomer base prior to amalgam placement.
This study compared microleakage resistance among amalgam restorations placed with and without light-cured glass-ionomer base materials. Preparations were made in extracted human molar teeth. Four groups were studied, including copal varnish, which was used as a control. All specimens were restored with amalgam. Results indicated significantly greater leakage at the cavity wall/base interface for restorations with a copal varnish cavity liner than for those with a glass-ionomer base. Leakage differences among bases were also found at the amalgam/base interface. Best results were obtained with a dual-cure resin-based system. These samples showed minimal leakage at both the cavity wall/base and the base/amalgam interfaces. These findings suggest that light-cured glass-ionomer bases can be effective in the prevention of microleakage in amalgam restorations.     

Radionuclide skeletal imaging and single photon emission computed tomography in suspected internal derangements of the temporomandibular joint

Fifty one subjects who had pain involving the temporomandibular joint were evaluated using multidirectional tomography, arthrography, conventional nuclear scanning, and single photon emission computed tomography (SPECT) to assess the association of arthritis of the temporomandibular joint with internal derangements related to meniscal dysfunction. Five (56%) of the nine subjects who had normal arthrograms and normal multidirectional tomograms had SPECT scans that were positive for osseous changes. Twenty-two subjects (27 temporomandibular joints) were diagnosed by arthrography to have meniscal displacement with reduction. Multidirectional tomograms of the 27 joints were positive for osseous changes in five (18%) joints, whereas SPECT scans were positive in nine (70%) joints. Twenty subjects (20 temporomandibular joints) had an arthrographic diagnosis of meniscal displacement without reduction. Multidirectional tomograms of the 20 joints were positive for osseous changes in 14 (70%) joints, and SPECT scans were positive in 16 (80%) joints (P less than 0.001 vs control group). Initial observations with SPECT indicate it is a promising imaging method for detecting and staging osseous disease of the TMJ related to meniscal dysfunction.     

Serum neutralizing activity against Actinobacillus actinomycetemcomitans leukotoxin in juvenile periodontitis

A relatively high incidence of infection by Actinobacillus actionomycetemcomitans can be shown in subgingival plaque samples obtained from patients with juvenile periodontitis. These organisms possess a potent leukotoxin(s) which rapidly destroys isolated human polymorphonuclear leukocytes (PMNs) and monocytes. If such leukotoxins operate in vivo, they could deprive the gingival crevice area of an essential antibacterial defense mechanism. We have found that sera from juvenile periodontitis patients consistently (greater than 90%) contain antibodies which neutralize Actinobacillus actinomycetemcomitans leukotoxin(s). On the other hand, sera from normal individuals or patients with other types of periodontal disease usually amplified rather than inhibited the leukotoxic reaction. Many patients with juvenile periodontitis have demonstrable defects in PMN or monocyte chemotaxis and this may place them at risk to gingival infection by Actinobacillus actinomycetemcomitans. The immune response against these organisms could be a crucial determinant in the course of juvenile periodontitis. While this disease is relatively rare, it does cause immeasurable emotional, physical and economic hardship for patients and their families. The identification of Actinobacillus actinomycetemcomitans as a potential pathogen in this disorder may eventually lead to specific forms of therapy to prevent and eliminate infection by this organism in these patients.     

The reaction of dental tissues to magnetic fields*

ABSTRACT The effects of cobalt samarium magnets on the dental tissues of dogs has been examined. After an exposure period of six months there was no evidence, clinically or microscopically, of tissue damage.     

Ultrastructural features of the verruciform xanthoma

The verruciform xanthoma, a rare lesion of the oral cavity, was studied by light and electron microscopy. The major cell type associated with the lesion was shown to contain appreciable amounts of lipid and was characterized as a macrophage. It was characteristic of the endothelial cells associated with subepithelial capillaries to exhibit multiple basal laminae. A rather unusual observation was the migration of lipid-filled cells into the stratum germinativum of the overlying epithelium.