Te niho waiora me te iwi Maori: dental health and the Maori people

The standard of dental health for Maori people is still far below that of the non-Maori (Pakeha or European) in this country. Their dental health needs are not being met by the dental profession. However, by making the delivery of dentistry culturally acceptable to Maori people and making dentistry appropriate and accessible for Maori people, much can be achieved. The Maori Dental Health Clinic at the School of Dentistry has shown this in the short time of its existence. One cannot change the way in which a restoration is done, but one can change the approach in which that restoration is done. By acknowledging and recognising the importance of the whanau, the family, in the delivery of dental health services, the dental profession in this country can go a long way to improve the dental health of the Maori people. Kia ora koutou katoa.     

Assessing dental manpower needs in Tennessee

Using a formula developed by the State of Kentucky and the best data available for the State of Tennessee, it is estimated that this state currently has a slight oversupply of dentists, but that by the turn of the century this will have become a shortage. There is no reason to doubt these estimates except that for confidence in them we will need state-specific data on the supply of dental manpower, the need for dental care, and the demand for dental care. Following the recommendations of the Institute of Medicine and others, the College of Dentistry has initiated the Dental Manpower Project to develop and maintain a database which will allow Tennessee to forecast and monitor trends in the supply of dental personnel and factors affecting need and demand. Hopefully, such an activity will help us avoid mistakes like those made 25 to 30 years ago which resulted in the education of too many dentists nationwide (and in this state) and an unfortunate breach between practitioners and dental education.     

Tumor antigen presentation: changing the rules

The relationship between dental status and dental anxiety was analysed in 165 patients. To assess the dental status, D3.4 MFS-index and Bleeding-on-Probing-Index (BOP) were applied. Dental anxiety was assessed using dental anxiety rating, whereas aspects of state and trait anxiety were analysed by the State-Trait-Anxiety Inventory. The hypothesis was: higher levels of dental anxiety lead to avoiding check-ups and necessary treatment, the consequence of which is a deterioration of the dental status. No significant correlation was found between dental anxiety and dental status. A significant difference was found when comparing patients with high or low dental anxiety in respect of the D3.4 MFS-index, whereas a different trend was found on comparing these groups for BOP-index. In addition, a significant correlation was found between dental anxiety and trait anxiety. These results suggest that dental anxiety is a rather non-specific phenomenon, since it is an aspect of proneness to anxiety. In addition, in patients who display considerably high dental anxiety, this may lead to anxiety denial and abnormal behaviour (e.g. avoidance of dental hygiene or care) thus contributing to further deterioration of oral health.     

Anthropology, tooth wear, and occlusion ab origine

The purpose of this essay is to emphasize that anthropology, the study of man in his environments, is a potent tool for scientific discovery and inspiration in dental science. It attempts to capture flashes of creative anthropological insight which have illuminated studies of tooth wear and occlusion in the past. While it documents contributions, understandings, and misunderstandings from Australian and New Zealand dentists, it is not a hagiography. The real saint of this essay is the Australian aborigine. For when men and women are understood in their environments, much is learned from them which challenges preconceptions of our dental science culture. The essay concludes that new, contemporary Australian culture needs to be studied by anthropological approaches if we are to understand how dental erosion is exacerbating tooth wear and damaging the occlusions of contemporary Australians. Much remains to be discovered about contemporary lifestyles, habits, and diets that lead to dental erosion, the principal cause of contemporary tooth wear in this part of the world.     

The effectiveness of acupuncture in treating acute dental pain: a systematic review

OBJECTIVE: Acupuncture is frequently advocated as an effective treatment of dental pain. The question whether or not it is effective for this indication remains controversial. The aim of this systematic review therefore was to assess the effectiveness of acupuncture in dental pain. DATA SOURCES: Four electronic databases were searched: Medline, Embase, CISCOM, and the Cochrane Library. Only controlled trials were included in this review. DATA EXTRACTION: Information was extracted from included studies and entered on standard forms independently by both authors. Methodological quality was assessed using the Jadad score. MAIN RESULTS: 16 such studies were located. The majority of these trials imply that acupuncture is effective in dental analgesia. However, important questions remain unanswered. CONCLUSION: It is concluded that acupuncture can alleviate dental pain and that future investigations should define the optimal acupuncture technique and its relative efficacy compared with conventional methods of analgesia.     

Dental health attitudes among dentate black and white adults

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.     

Prevention of deep venous thrombosis

Two studies of self-referred patients attending emergency dental clinics in Edinburgh have shown that almost half of the patients have been to the dentist in the last year and 60% had routine treatment on their last dental visit. Despite this contact with dental services, over 40% of patients with a dental emergency who attend the emergency dental clinics say that they do so because of actual or perceived difficulty in obtaining immediate care from the general dental services. Some 17% attend the clinics for reasons of convenience and 19% of patients attend the emergency clinic at the Dental Hospital because they prefer to be treated in a 'centre of excellence'. In September 1994 the School of Dentistry is to close and the Dental Hospital relocated. Changes may have to be made to the organisation of general dental practice in the Edinburgh area to accommodate patients with a dental emergency. The majority of emergency dental patients in Edinburgh are not put off attending for the relief of their problem by the cost of National Health Service treatment.     

Indices of treatment needs in orthodontics: the applicability of the DAI (Dental Aesthetic Index)

The objective assessment of esthetic impairment and relative psychosocial handicap for unacceptable dental aspect (useful for characterizing the need of treatment), could be satisfied by an index that measures each individual's occlusal trait and the psychological impact of the same. An index with these characteristics was suggested by Cons and Jenny, already since 1985. This is an index (DAI: Dental Aesthetic Index) designed specifically to measure dental esthetics, based on esthetic standards socially defined and focused through an extensive and finalized search. Therefore this index assesses the social acceptability of the dental appearance based on the public perception of dental esthetics. The authors, in this work, indicate as measuring the objective traits of occlusion and arriving to final score trough simple calculation. This score provides severity levels of esthetic, psychologic and functional impairment relative to dental aspect in examination.     

An experimental study of the interleukin 1 levels in aqueous humor after intraocular lens implantation

Identification of unknown bodies is mainly made by dental examination and comparison with accurate dental records. Therefore it is necessary to examine the jaws carefully and to locate every tooth-coloured dental restoration. Overlooking dental fillings can make positive identification impossible. The technique described prepares the natural dental hard tissue by etching with 37% phosphoric acid. In the next step an indicator colours the roughened dental tissue but not the polished restoration material. In this way all 15 tested dental restoration materials could be detected with high sensitivity.     

Equilibrium vapour pressure of mercury from dental amalgam under loading conditions

Earlier studies have failed to establish a consensus on the amount of mercury vapour released from dental amalgam restorations. The purpose of this study was to accurately and quantitatively measure the equilibrium mercury vapour pressure from dental amalgam. The vapour pressure was measured using a quartz crystal microbalance as a function of the load from 0-5.4 MPa. Auger spectra were collected of the as-formed and argon ion sputter cleaned dental amalgam surface. For the as-formed surface the mercury vapour density is zero with no load and increases to 0.6 microg m(-3) at 5.4 M Pa. Following cleaning the mercury, vapour density increased to a maximum value of 15 microg m(-3). The Auger spectra of the as-formed surfaces were dominated by features associated with carbon and oxygen. These spectral results in concert with the mercury vapour density measurements indicate that the oxide film on the as-formed surfaces inhibited the release of mercury vapour. The results of this experiment provide an upper limit for the amount of mercury vapour released by dental amalgams. Under conditions simulating the oral cavity this value would be reduced by oxides that form on the surface of dental amalgam restorations.     

Compliance in dentistry: general adherence, specific adherence and perceived dental health

In this study it was attempted to replicate findings on the relationship between general and specific adherence and perceived health in the context of dental treatment. Furthermore the psychometric characteristics of a modified adherence scale for use in dental populations were investigated. A sample of 167 freshmen completed a questionnaire containing a general adherence scale (GAS) developed by DiMatteo et al. (Oncology 1992;6:50-7), a perceived health scale, a perceived dental health scale, and two items about adherence to recommendations on dental behaviour. The GAS showed adequate internal consistency. Positive correlations were found for general adherence on the one hand and for specific adherence, perceived health, and perceived dental health on the other. The results concerning the GAS and specific adherence do not correspond with the findings of DiMatteo et al. It is suggested that this discrepancy is due to the situation-specificity of adherence in combination with differences in the samples and the specific adherence measures used in both studies.     

Finishing touches for beautiful smiles: orthodontist and general dentist coordinate efforts to achieve optimum esthetics. Part II

It is not uncommon for teeth to still not be attractive, even though they are straight following treatment. Several examples have been given of what can be done to improve the attractiveness of teeth when this occurs. It is the responsibility of the dental team involved in the management of a persons total dental care to advise patients of what dental services are available to them. People should have the opportunity to evaluate what dental services are needed to accomplish a pleasing result that is satisfying to them and to the dental team involved.     

Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark

Gastroesophageal reflux (GOR) is often a self-limiting condition but nevertheless is a common cause of morbidity in childhood. Studies of adult patients with hiatus hernias and GOR have suggested that there is an increased incidence of dental erosion in these individuals. The aim of this study was to investigate the relationship between dental erosion and GOR in children. Fifty-three children aged 2 to 16 yr (mean 4.9 yr) with moderate to severe GOR, defined by pH monitoring, were examined for dental erosion. A questionnaire investigating dietary habits, other relevant medical conditions, and erosion risk factors was also completed. Results showed that the prevalence of dental erosion was low, when compared with the UK National Survey, with only 9 (17%) children showing any signs of erosion, and of these only one had erosion involving dentine. These results suggest that dental erosion may not be as great a problem in children with GOR as it is in adults. It may be that refluxing is limited to the oesophagus, and further work is needed to investigate those children that positively reflux into the mouth.     

Periodontal and dental considerations in clinical crown extension: a rational basis for treatment

When the clinical crowns of teeth are dimensionally inadequate, esthetically and biologically acceptable restoration of these dental units is difficult. Often an acceptable restoration cannot be accomplished without first surgically increasing the length of the existing clinical crowns; therefore, successful management requires an understanding of both the dental and periodontal parameters of treatment. This report provides further insight into this interdependence by examining the effects of tooth form on the periodontal morphology and surgical treatment, while relating them to requirements for esthetically and biologically acceptable full-coverage dental restorations. This report also explains the role that restoration margin location and emergence profile play in the maintenance of periodontal and dental symbiosis. The effects of violation of the supracrestal gingivae by improper full-coverage restorations is also illustrated.     

A longitudinal study of the dental care of adults in the general dental service in Scotland: the first 6 years, 1988-1994

OBJECTIVE: To provide an overview of routine dental care for adults attending the general dental service in Scotland, in a more detailed manner than is currently possible from national data sets. DESIGN AND SETTING: Cohort study in the general dental service. SUBJECTS AND METHODS: The cohort consisted of 992 Scottish dentate adults who participated in the adult dental health survey of 1988, conducted by the Office of Population Censuses and Surveys. Details of subsequent treatment undertaken in the general dental service were provided by Dental Practice Division, Edinburgh. MAIN OUTCOME MEASURES: Production of patient-specific and tooth-specific data on dental attendance and treatment. RESULTS: 71% of the cohort attended at least once in the 6 years. Registration levels, following the introduction of the continuing care contract, reached 42-44%. Observed lapses in registration illustrate the changing membership of the relatively static level of registration year-on-year. Vulnerability to treatment of different tooth sites is illustrated graphically. CONCLUSIONS: Cohort studies provide valuable information on patterns of attendance and treatment needed for planning of dental health services. Growing computer power and increasing demands for management data may mean that future work of this nature can be more appropriately undertaken at the population level.     

The effects of visual surround eccentricity and size on manual and postural control

The aim of this study was to compare two different modes of behaviorally-oriented therapies for dental fear. The subjects were chosen consecutively from the waiting-list of a Dental Fears Research and Treatment Clinic. In addition, a control group was selected from patients treated under general anesthesia to compare levels of dental and general fear with the experimental groups. Twenty-two women, with a mean age of 31.8 yr, were included and randomly assigned to two groups. The median time of avoidance of dental care was 9.5 yr. One group received hypnotherapy (HT) and one group a behavioral treatment based on psychophysiological principles (PP). Both therapies included eight sessions followed by standardized conventional dental test treatments. Pre- and posttreatment measures were dental fear, general fear, mood, and patient behavior. Nine patients were not able to conclude the treatment sessions (6 HT and 3 PP); these patients did not differ significantly from the remaining patients before treatment. The PP group reported a statistically significant decrease in dental fear as well as a rise in mood during dental situations, as opposed to the HT group. General fear levels decreased but not significantly. Eleven patients completed conventional dental treatment according to a dentist's behavioral rating scale, indicating that they were relaxed, and no problems occurred during the treatments. These patients were referred to general practitioners within the community dental service. In conclusion, this small size study showed that a majority of the patients, who accomplished the behavioral therapy and the dental test treatments, became less fearful of dental care and were able to manage conventional dental care, including changing dentist.     

Twenty commonly dispensed medications at a United States military installation and their significance to dentists

Understanding the clinical pharmacology of medications commonly used by dental patients is necessary when providing dental care. A significant number of patients may be taking medications that have the potential for adverse effects. The purpose of this paper is to familiarize dental practitioners with the clinical pharmacology of medications most likely to be encountered in a current military dental practice. Product activity reports (records of medications usage) were obtained from the main pharmacy at a United States Army Community Hospital. The product activity reports covered a 1-year period from December 31, 1992, to December 30, 1993. These reports were analyzed according to the number of medications dispensed to determine the 20 most commonly used medications.     

What do people want from dentistry? An action research approach

Issues surrounding access to dentistry will be presented from information gathered during an action research project targeting three population groups. This project was conducted by students in the Dental Hygiene Degree Completion Program at the University of British Columbia and by the dental hygiene diploma students at Camosun College. In contrast to typical empirical dental studies which are validated by statistical presentation, action research uses an interview process and qualitative analysis to identify what people really think, believe and do. College students, independent-living seniors, and low-income families were interviewed to determine how they accessed dental care, how they liked their dental visits, and how they preferred to receive dental health information. Cost, convenience and fear of pain were significant factors which influenced whether people attended the dental office. Caring dental health providers, comfort and pleasant physical surroundings were important features of a dental office visit. Dental health practices, such as brushing and flossing, were predominantly learned from the dental profession at the dental office, through school programs, or from parents at home. This data challenged our previous assumptions about these groups. As the goal of this type of research is "action", the information gathered will lead to action plans at the community and professional level.