Predictable exodontia in general practice

Exodontia that is carefully and skillfully done by general dentists is a valuable service to patients. The majority of patients would rather have their family dentist perform necessary extractions or other minor surgery procedures than be referred outside the office. Most teeth that need to be extracted could be removed by a generalist if that person has developed the expertise to do not only relatively easy extractions, but also that percentage that is inevitably more difficult--requiring "surgical" removal. To be successful with exodontia, the dentist must have the ability to select cases within his or her level of comfort and ability, have a working knowledge of sound surgical principles, be able to apply a variety of patient management techniques, and then be prepared to handle whatever complications may arise. This article has presented ideas that should be integrated into the operator's own systematic approach to extractions. It is one of many resources to help the general dentist provide a higher level of surgical treatment.     

Pediatric dentists' attitudes regarding parental presence during dental procedures

A controversial aspect of pediatric dentistry today is parental presence. A number of authors report an increase in the number of parents who wish to accompany their children throughout the dental appointment. Dentists historically have excluded parents from the treatment area, while pediatricians routinely keep the parent and child together. The purpose of this survey was to determine the frequency that Florida pediatric dentists permit parental presence during children's dental visits and to relate the influence of patient age, dentist's years in practice, procedure type, and practitioner attitudes on parental presence. A high return rate (98.9%) was obtained, and results indicated a significant increase in parental presence in the dental operatory and that further increases in parental presence are expected. Younger children were more likely to be accompanied by a parent for each procedure. Parental presence for examination was more likely than for restorative or extraction. Analysis of variance (ANOVA) indicated that the most frequent attitudes influencing the pediatric dentist's choice to exclude parents were that their presence: wastes time (P < 0.001); disrupts the child (P < 0.05); and makes the dentist uncomfortable (P < 0.05).     

Tiamulin selectively inhibits oxidative hepatic steroid and drug metabolism in vitro in the pig

An enquiry among 50 successful, general dental practitioners working under a capitation payment system for the treatment of children, showed that they all thought that prevention on selected patients was of value to their practice. They said that prevention enhances the reputation of the practice, adds to the job satisfaction of the dentist and is part of modern dental philosophy. However, only when practised selectively would it be cost: beneficial. The most popular preventive treatments were fissure sealants, particularly when used on selected patients, oral hygiene demonstrations and, among a group of enthusiastic dentists, dietary counselling. Dentists who employed hygienists had a significantly higher 'mean preventive awareness score' than those who did not.     

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.     

Adenocarcinoma arising in "J" pouch after total proctocolectomy for familial polyposis coli

Cigarette smoking has a major impact both on oral health and general systemic health. Because up to 70 percent of smokers see their dentists each year, the dentist is in a very powerful position to intervene with the smokers to help them stop smoking. I have suggested a four-step program for assisting patients to quit, based on the National Cancer Institute's suggested protocol for the dental office, which uses techniques shown in clinical trials to be effective for helping smokers quit. The core of the NCI program involves identifying smokers, advising them to quit, providing assistance to patients trying to quit, and following-up on patients as a means of enhancing success rates. Dentists who implement an effective smoking cessation program in their practices can expect to achieve quit rates up to 10 to 15 percent each year among their patients who smoke. Such a rate of success, if established nationwide and continued over a period of years, would markedly reduce the prevalence of smoking in the United States.     

Patient satisfaction with dentures made by dentists and denturologists

BACKGROUND: Within Quebec and elsewhere in Canada, patients requiring removable prostheses consult either dentists or denturologists. In this article, we describe the socioeconomic characteristics of 410 edentulous individuals seeking replacement of their dentures, and compare the levels of satisfaction experienced by the patient groups provided with conventional dentures by dentists and by denturologists. METHODS: All subjects responded to announcements seeking participants in a clinical trial. The announcements indicated that all participants would receive new prostheses. Data were collected via telephone interviews. Sociodemographic variables included sex, age, education level and family income. Subjects were asked to evaluate their present maxillary and mandibular prostheses for general satisfaction, stability, comfort, ability to chew, ability to clean and appearance. Age, cost and the provider (dentist or denturologist) of the original prostheses were also recorded, and responses were then compared between the groups of subjects treated by dentists (N = 91) and denturologists (N = 319). RESULTS: There were no significant differences in the sociodemographic characteristics of the two groups, except for a small difference in mean age (two years). Both groups had paid approximately the same amount for their complete prostheses. As expected, most individuals were satisfied with their maxillary prostheses, but dissatisfied with their mandibular prostheses. Significantly more subjects in the denturologist treatment group than the dentist treatment group gave their mandibular prostheses a poor rating for general satisfaction (p = 0.003), comfort (p = 0.04) and stability (p = 0.016). CONCLUSIONS: These results suggest that the edentulous patients treated by dentists and denturologists share similar sociodemographic characteristics, and pay a similar cost for treatment. However, those treated by denturologists seem to be more dissatisfied with their mandibular prostheses than those treated by dentists.     

Management of temporomandibular disorders in a restorative practice

Various disorders related to the masticatory muscles or to the temporomandibular joints may be encountered in a restorative dental practice. Most of them can be managed by the restorative dentist whose primary interest may not lie in the area of temporomandibular disorders. The term temporomandibular disorders is used in this discussion to denote the group of diseases of the masticatory system that involves primarily the temporomandibular joints, the masticatory muscles, and the occlusion of the teeth. The learning objective of this article is to describe temporomandibular disorders encountered in general practice. Managing these disorders in the general practice of restorative dentistry is not difficult and adds to the comfort of the patient and possibly to the success of the restorations.     

Comparison of assisted reproductive technology performance after oocyte retrieval under general anaesthesia (propofol) versus paracervical local anaesthetic block: a case-controlled study

Propofol (Dipirivan) is an intravenous anaesthetic drug used for general anaesthesia. Although frequently used as a general anaesthetic for ultrasound procedures, its use during transvaginal oocyte retrieval is currently being debated. A total of 202 patients undergoing fertility treatment was included in a prospective, matched, controlled study, in which we compared fertilization rates and embryo development in terms of morphological quality and speed of development and the implications for reproductive outcome and pregnancy following general anaesthesia using either propofol or a paracervical local anaesthetic block during oocyte collection. There were no differences between the fertilization rates and the embryo cleavage characteristics for the two groups. The initial implantation rate per transferred embryo after general anaesthesia was similar to that after paracervical local anaesthetic block (13.4 versus 18.6%; P = 0.10). The ongoing clinical implantation rates per embryo transferred were also similar in the two groups.     

Syphilis and gonorrhea

Syphilis and gonorrhea are prevalent in the United States; thus it is likely that the practicing dentist will encounter these sexually transmitted diseases. Oral-genital contact can result in oral and oropharyngeal lesions of both syphilis and gonorrhea. In most states, the law mandates reporting of these sexually transmitted diseases to local health departments. Dentists must wear gloves, masks, and protective eyewear for all procedures resulting in physical contact between the patient and practitioner. Universal infection control procedures must be carefully followed to ensure against disease transmission from the symptomatic as well as the asymptomatic disease carrier.     

Lymphangioma in the metacarpal pad of a dog

OBJECTIVES: To estimate odontogenic bacteraemia following three different types of local anaesthetic injections, namely: buccal infiltration analgesia (BIA), conventional intraligamental analgesia (CIA), and modified intraligamental analgesia (MIA). PATIENTS AND METHODS: The bacteraemia-producing potential of three methods of injecting local analgesic solution was determined by taking blood samples, using aseptic technique, from 143 children, aged 1 year 11 months to 19 years 4 months, undergoing general anaesthesia for dental extractions. Of these 143 children, a subgroup of 50 had blood taken before any dentogingival manipulative procedures to provide a baseline level of bacteraemia. The injection methods were buccal infiltration, conventional intraligamental, and a modified intraligamental. The blood samples were taken 30 seconds after injection and cultured in aerobic and anaerobic broth cultures (Bactec) and from lysis filtration vials (Isolator). RESULTS: The percentage prevalence of bacteraemia was: baseline level 8%; buccal infiltration analgesia 16%; modified intraligamental analgesia 50%; and conventional intraligamental analgesia 97%. These values were statistically significantly different using the chi-squared test (P < 0.001). The mean value for colony forming units per millilitre (Isolator system) was 252 (sd = 646) for the intraligamental technique but zero for baseline, infiltration and modified intraligamental techniques. CONCLUSIONS: All local anaesthetic techniques studied were associated with bacteraemia which may have implications for antibiotic prophylaxis for dental treatment. The intraligamental techniques had statistically significantly greater percentage prevalence of bacteraemia compared with baseline. The modified intraligamental technique causes significantly less bacteraemia than the conventional intraligamental technique.     

Outpatient haemorrhoidectomy under local anaesthesia

OBJECTIVE: To compare early and late results and costs of outpatient haemorrhoidectomy under local anaesthesia with those of inpatient haemorrhoidectomy. DESIGN: Prospective study with historical controls. SETTING: University hospital, Brazil. SUBJECTS: 51 patients who required haemorrhoidectomy. INTERVENTIONS: Outpatient haemorrhoidectomy under local anaesthesia. MAIN OUTCOME MEASURES: Early and late results and comparative costs. RESULTS: One patient was withdrawn from the study because of hypertension and subsequently lost to follow-up. The remaining 50 patients were discharged a mean of 68 (23) minutes after operation. Twelve patients complained of severe pain, one had faecal impaction and 2 developed bleeding. One patient developed urinary retention, compared with 18 in the historical group (p < 0.001). Forty-two patients (84%) were thoroughly satisfied with their treatment. Late complications did not differ significantly from those observed in the historical group. The estimated hospital costs were US$ 313.6 for outpatient, and US$ 716 for inpatient treatment. CONCLUSION: Outpatient haemorrhoidectomy under local anaesthesia was safe and comfortable for most patients, with complication rates comparable to or better than those observed after inpatient treatment and at less than half the cost.     

Use of preoperative subcutaneous "wetting solution" and epidural block anesthesia for liposuction in the office-based surgical suite

Uniform saturation of subcutaneous fat using the "wetting solution" formula described by Klein for his "tumescent technique" has been shown to decrease operative blood loss associated with liposuction procedures and to eliminate the requirement for general anesthesia for selected patients. However, we found this infusate provided an inadequate level of anesthesia for many of our patients. We use preoperative infusion of Klein's epinephrine and lidocaine containing wetting solution in our lipoplasty practice only for control of blood loss and postoperative pain. Our anesthetic of choice for liposuction is the epidural block technique, which provides consistent intraoperative comfort for the patient. We report our experience with 85 consecutive lipoplasty patients who underwent liposuction under epidural anesthesia after subcutaneous fat perfusion with Klein's wetting solution. Our epidural block technique uses the rapidly metabolized local anesthetic agent, chloroprocaine, which has the lowest systemic toxicity risk of any local anesthetic agent. Chloroprocaine's anesthetic characteristics are particularly well suited for the outpatient surgery patient with few undesirable side effects.     

Midazolam versus placebo before spinal anesthesia

The goal of this randomized, double blind and multicentric study was to compare the effects of midazolam (M) and placebo (P) administered by titration before puncture for spinal anaesthesia on the comfort of 211 patients scheduled for elective surgery after oral premedication with hydroxyzine. The administered dose of midazolam was 3.4 +/- 1.3 mg (mean +/- SD). Anxiety was nil in 92% of the patients of the M group and in 64% of the patients of the P group (p < 0.001) and memorization of the pain of the puncture was reported in 34% of the patients of the M group and in 66% of the patients of the P group (p < 0.001). However cooperation of the patient and easiness of the puncture were similar in both groups. In conclusion titrated sedation with midazolam before puncture for spinal anaesthesia increases the comfort of the patient.     

The incentive effects of malpractice liability rules on dental practice behavior

OBJECTIVES: The impact of malpractice liability rules on dental practice behavior was estimated using data from a 1992 nationwide survey of US general dentists. The study examined the premise that malpractice liability rules can affect quality of care and related resource allocation decisions by dentists, but that market features, such as relatively complete and "non-experience rated" malpractice insurance, are likely to weaken the incentive effects of malpractice liability. METHODS: General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. Secondary data on county-level characteristics were used to measure market area factors. Quality-of-care measures were derived from the survey about self-reported practice policies and behavior and participation in continuing education. Legal measures were assembled from state statutes and appellate court decisions. Ordinary least squares was used to assess the relation between legal variables and dependent variables of quality of care, continuing education, and the rate of dental output. RESULTS: Hypotheses about the effects of malpractice law on practice quality and participation in continuing education were not supported. The relation between pro-dentist law and output was supported. A number of legal provisions related to differences in practice behavior, but often in ways opposite to the expected direction. CONCLUSIONS: The direct effects of specific malpractice liability rules on dentist practice behavior often failed to point in the direction predicted by theory and were economically insignificant. It is possible that relatively complete malpractice liability insurance, coupled with "noisy" liability rules, substantially dulls the deterrent effect of malpractice liability. Other forces, such as the dentist's past malpractice claims experience, were more significant in shaping dentist behavior.     

Transarterial brachial plexus anesthesia for hand surgery: a retrospective analysis of 346 cases

STUDY OBJECTIVES: To study the safety and efficacy of the transarterial approach to brachial plexus block with 60 to 70 ml of local anesthetic solution, and to compare the success and complication rates of this block performed by experienced or inexperienced anesthesiologists. DESIGN: Retrospective analysis of 346 records of ASA physical status I-IV patients who underwent elective unilateral orthopedic upper limb surgery with transarterial plexus anesthesia. SETTING: University teaching hospital. MEASUREMENTS AND MAIN RESULTS: Blood pressure (BP) and heart rate were measured at 5-minute intervals. Analgesia was registered as successful, incomplete, or failed. Any patient complaints or adverse reactions were recorded. The first 60 ml of local anesthetic provided surgical analgesia to 64% of patients. With a supplemental 10 ml of anesthetic, the overall success rate was 94%, with only 19 of 346 patients requiring general anesthesia. Experience in performing the block increased the success rate from 90% to 98% (p < 0.001). Six patients experienced either nausea or a transient BP decrease that did not require medication. There was no record of toxic or other serious adverse reaction. CONCLUSIONS: Transarterial brachial plexus block administered with a 60 to 70 ml dose of local anesthetic provides surgical analgesia for hand surgery with an excellent success rate and without serious adverse effects.     

Factors associated with dental anxiety

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's month, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.     

Use of drugs in dentistry I. Introductory study

The authors summarized 514 questioners on the dental patient medication in the general stomatological practice. In the 10 medication group they count 135 different drugs. The number of different minor analgesics were 28 the medicines for local application 26, and the brand of antibiotics 22. The hungarian dentist use 23 different drugs, 5 antibiotics, 5 medicine for local application. An average of the dentist monthly dosage is 97.6 box of medicine (29 antibiotics, 23.2 minor analgesics, 18.4 local anesthetics, 17.5 local drugs). The 70% of the medicines hungarian origin in the dental practice.     

A case of Rathke''s cleft cyst with apoplexy

OBJECTIVE: To develop and evaluate a model of integrated primary dental and medical care. DESIGN: 3-year prospective study. SETTING: A general dental practice and a general medical practice occupying the same building in Glasgow. INTERVENTION: Regular staff meetings, joint use of patient records systems and information derived from patient questionnaires. Dentistry was included in established screening programmes such as child health surveillance and care of elderly. Staff were encouraged to participate in joint work practices and joint consultations were carried out. MAIN OUTCOME MEASURES: Patient registration, avoidance of discrepancies in information, reduction of secondary referrals, joint work practices. RESULTS: The number of registered joint patients attending both medical and dental practices increased by 90%. The joint use of patient record systems avoided discrepancies in patient information which would have affected the quality of patient care. Including dentistry in child health surveillance and care of elderly screening programmes resulted in an increase in 0-5 year olds registering with dentists from 36% to 68% (P < 0.001) and with > 75 year olds from 47% to 71% (P < 0.001). Joint consultations reduced the need for secondary referrals. CONCLUSIONS: This model of health care demonstrated the potential for coordination and integration of functions between the dental team and the primary care team. Integrated primary dental and medical care requires attitudinal change in health care professionals and requires greater emphasis in education and training of health care professionals in the future.     

Hair analysis for nordiazepam and oxazepam by gas chromatography--negative-ion chemical ionization mass spectrometry

The sub-Tenon's technique uses blunt dissection and a blunt probe to inject local anaesthetic into the posterior sub-Tenon's space. This avoids the potentially catastrophic complications which result from passing a sharp needle blindly into the orbit and retrobulbar space. The anatomy of Tenon's capsule and the block technique is described. Results of the block quality and degree of patient comfort from 300 consecutive sub-Tenon's blocks are also described. No significant complications occurred in this series. Single-quadrant sub-Tenon's block offers an excellent quality of anaesthesia, is virtually painless to perform and avoids complications due to passage of a sharp needle into the orbit.     

Sonography, CT, CT sialography, MRI and MRI sialography in investigation of the facial nerve and the differentiation between deep and superficial parotid lesions

Three types of veneer restorations (VRs) were evaluated for recognition by two groups of observers to study the aesthetic result. The different types of VRs were: porcelain, direct resin composite and indirect resin composite. One month after insertion of the VRs, colour transparencies were made of smiling patients randomly selected from a group of 112 patients participating in a clinical trial. The slides were evaluated by five dentists who were not familiar with the patients and by 25 beautician students (BS). Dentists were asked to locate the VRs which were present in the patients and to specify the type of VR. BS were only asked to locate the VRs. To trace a possible relationship between the aesthetic result of the treatment and a number of variables, ANOVA was applied to evaluate the variables: 'discolouration of the teeth' before treatment, 'type of VR' and 'number of VRs'. Agreements in judgement were expressed in Cohen-Kappa coefficients. The results showed that the dentists could locate the VRs quite well (Kappa coefficient 0.64 +/- 0.28) but for BS this was lower (Kappa coefficient 0.43 +/- 0.27). The more VRs were made in one patient, the more difficult it was to locate them correctly. The other variables had no significant effect on the recognition of the VRs. It was not possible for the dentist observers to differentiate between the types of VRs.