Luc Marks

Dyract versus Tytin Class II Restorations in Primary Molars: 36 Months Evaluation

Due to the changed treatment approach of proximal caries and the amalgam controversy, clinicians are in search for new materials. The aim of the present study was to compare amalgam with an adhesive material in deciduous molars in a clinical, split–mouth design study. At baseline 30 polyacid modified composite (Dyract®) and 30 amalgam (Tytin®) restorations were placed in primary molars, of which 24 and 17 could be evaluated after 24 and 36 months, respectively. Modified USPHS criteria were used for clinical evaluation every 6 months. Annual bite–wing radiographs were taken for evaluation of recurrent caries and cervical gap formation. In the present study, for Dyract as well as for Tytin restorations, low rates of recurrent caries were found, while Dyract restorations showed a better marginal adaptation and surface texture compared to Tytin restorations. In the Dyract group more radiolucencies were found at baseline. In both groups no patient complaint or pain was reported related to the radiolucencies. After 3 years the colour of Dyract was not comparable to the original. For Dyract no excessive wear was noticed compared to enamel. During the study one Dyract (recurrent caries: 18 months) and two Tytin (pulpal aetiology: 6 months, recurrent caries: 36 months) restorations had to be replaced. Even though the restorations were placed in caries risk children, at the 36 months’ evaluation of this clinical study, the results indicate that Dyract can be an alternative for Tytin in the primary dentition.

An Evaluation of Using Population Pharmacokinetic Models to Estimate Pharmacodynamic Parameters for Propofol and Bispectral Index in Children

Background:To study propofol pharmacodynamics in a clinical setting a pharmacokinetic model must be used to predict drug plasma concentrations. Some investigators use a population pharmacokinetic model from existing literature and minimize the pharmacodynamic objective function. The purpose of the study was to determine whether this method selects the best-performing pharmacokinetic model in a set and provides accurate estimates of pharmacodynamic parameters in models for bispectral index in children after propofol administration. Methods:Twenty-eight children classified as American Society of Anesthesiologists physical status 1 who were given general anesthesia for dental treatment were studied. Anesthesia was given using target-controlled infusion of propofol based on the Kataria model. Propofol target plasma concentration was 7 &mgr;g/ml for 15 min, followed by 1 &mgr;g/ml for 15 min or until signs of awakening, followed by 5 &mgr;g/ml for 15 min. Venous blood samples were taken 1, 2, 5, 10, and 15 min after each change in target. A classic pharmacokinetic-pharmacodynamic model was estimated, and the methodology of other studies was duplicated using pharmacokinetic models from the literature and (re-)estimating the pharmacodynamic models. Results:There is no clear relationship between pharmacokinetic precision and the pharmacodynamic objective function. Low pharmacodynamic objective function values are not associated with accurate estimation of the pharmacodynamic parameters when the pharmacokinetic model is taken from other sources. Conclusion:Minimization of the pharmacodynamic objective function does not select the most accurate pharmacokinetic model. Using population pharmacokinetic models from the literature instead of the ‘true’ pharmacokinetic model can lead to better predictions of bispectral index while incorrectly estimating the pharmacodynamic parameters.

Review: Finishing and polishing procedures of (resin-modified) glass ionomers and compomers in paediatric dentistry

Background: A smooth surface has a beneficial effect on the aesthetic quality and longevity of a dental restoration, as well as on its biocompatibility with the oral tissues. In this review studies on glass-ionomer cements (GIC), resin-modified glass-ionomer cements (RM-GIC) and compomers or polyacid-modified resin composites (PAM-C) were assessed as these are currently used in paediatric dentistry. Method: Medline database (U.S.A. National Library of Medicine) was searched using WinSpirs and PubMed. This search used a keyword filter including dental materials, polishing procedures, and instrumentation including influencing factors. Findings: Although the literature shows different commercially available tools it seems that the ideal polishing instrumentation in paediatric dentistry for GIC and compomers is not yet on the market. Furthermore, the constant development of dental materials and polishing products impose a need for continuing scientific research.

Oral health needs of athletes with intellectual disability in Eastern Europe: Poland, Romania and Slovenia

OBJECTIVES The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Poland, Romania and Slovenia. METHODS A cross-sectional study was performed with data collected through standardised oral screening of athletes who participated in the annual SO events held in Poland, Romania and Slovenia, between 2011 and 2012. The data were compiled and transferred to an SPSS data file for analysis using descriptive statistics. RESULTS A total of 3,545 athletes participated in the study. Among the main findings, the prevalence of untreated decay was 41% in Poland and 61% in Slovenia, whilst 70% of the Romanian athletes had signs of gingival disease and only 3.8% presented molar fissure sealants. In addition, 47% of Polish athletes were in need of urgent treatment. CONCLUSIONS Analysis of the results obtained following screening showed comparable oral health needs of athletes with intellectual disability among countries. Exploration of the oral health systems of the countries revealed similar significant co-payments and lack of incentive for dentists to treat patients with special needs. The results from Romania, Poland and Slovenia demonstrated the need for a structured system in which a special population is a target for oral-health-related education programmes and system-included preventive, restorative and maintenance interventions.

Literature review: Restorations of class II cavities in the primary dentition with compomers

BACKGROUND: A large number of studies concerning the use of compomers in class II cavities in the primary dentition already exist, but the variety of the research perspectives is even bigger. AIM: This study therefore intends to abridge and evaluate the existing research through a systematic literature review. METHODS: In order to gather relevant articles an extended literature research was carried out. The criteria for the evaluation of the resulting articles were based on the article of Kilpatrick and Neumann [2007]. RESULTS: According to the subject of the research, the articles were divided into the following groups: PAM-C; PAM-C and amalgam; PAM-C and GIC; PAM-C and hybrid composites; PAM-C and pre-treatment. CONCLUSIONS: The findings lead to the conclusion that PAM-C can be an alternative to other restorative materials in the primary dentition in class II cavities, except in the case of teeth with pulpectomies or pulpotomies. The placement of compomers takes longer than placing amalgam, but the procedure consists of fewer steps compared to composites. However, patient-compliance remains essential.

New toothpaste to deal with dentine hypersensitivity: double-blind randomized controlled clinical trial.

OBJECTIVES The purpose was to evaluate a combined effect of active ingredients contained in new toothpaste in reducing dentine hypersensitivity. METHODS The tested toothpaste contained active ingredients potassium nitrate (5.00%) and zinc citrate (0.50%). Pain to water stimulus and blowing air was reported on hypersensitive teeth and measured using the VAS (Visual Analogue Scale). The degree of pain to water stimulus was detected after each subject drank a few sips of water which was boiled to the room temperature. Data were collected on each subjects dental history. RESULTS A significant reduction in dentine hypersensitivity (26-29% after 2 weeks versus 40% after 4 weeks) was detected in the tested group. The controls also showed significant reduction to both stimuli, but at lower rate. A statistically significant difference to blowing air and water stimuli showed the highest impact for the tested group after 4 weeks (P = 0.033, P = 0.006). CONCLUSION This study supports the efficacy of the tested toothpaste in reducing the phenomenon of dentine hypersensitivity after 4 weeks of usage.

General dentists’ awareness of how to cope with medical emergencies in paediatric dental patients

BACKGROUND General dentists (GDs) should be aware of the symptoms, signs, diagnoses and treatment of medical emergencies in paediatric patients. AIM To evaluate the knowledge of GDs in coping with medical emergencies, and to identify whether they are confident to diagnose and treat medical emergencies in paediatric patients. DESIGN The questionnaire was conducted immediately before the beginning of national dental meetings and continuing education seminars in Croatia, attended by the GDs, in order to obtain a representative sample. RESULTS Of a total of 498 GDs who returned the questionnaire with valid data, 51.2% reported that a medical history was regularly taken. A high proportion (81.3%) of the GDs had never received any basic life support (BLS) training and education for paediatric patients during their undergraduate studies. After graduation, this value rose to 86.1% of GDs. However, more than two-thirds (68.7%) had experienced some emergency situation in their practice. The most frequent emergency was vasovagal syncope (83.6%) and the most rare was cardiac arrest (8.2%). One-fifth (20.5%) of GDs experienced some emergency but could not make a diagnosis. The more BLS training undergone by a GD, the more self-confident s/he felt in an emergency situation. CONCLUSIONS Most GDs have a lack of knowledge to cope with medical emergencies in paediatric patients, and do not feel confident to diagnose and treat emergency situations in children. It is suggested that adequate training and education should be provided for all GDs to address this shortcoming.

Clinical Guidelines for Implant Treatment in Patients with Down Syndrome

This study evaluated implant outcome in patients with Down syndrome (DSPs) and provides clinical guidelines to maximize treatment outcome. A total of 57 implants were placed in eight DSPs. During follow-up, implant survival was recorded and crestal bone level was evaluated when possible. After a mean follow-up time of 5 years, six patients with 45 implants were evaluated and an implant survival rate of 84.4% was recorded. A mean crestal bone loss of 1.7 mm (SD 0.9) was measured in three patients around 20 implants. Down syndrome is not a contraindication to dental implant placement, but multiple complicating factors yield reduced implant survival.

Accessibility to oral health care for people on social assistance: a survey of social service providers from Public Welfare Centers in Flanders

OBJECTIVES The goals of the present study were as follows: (i) to explore the characteristics of the Flemish Public Centers for Social Welfare (PCSW) concerning oral health care; (ii) to explore possible barriers experienced by people on social assistance and oral health-care providers; and (iii) to explore the accessibility of general and oral health care for people on social assistance. METHODS The data of this cross-sectional study were obtained by a survey of social service providers working in a PCSW. For this purpose, a new questionnaire was developed. The survey was validated by means of a pilot study. All 306 PCSWs in Flanders were invited to participate in this survey, of which 192 (62.7%) responded. RESULTS The findings demonstrate that for people on social assistance, financial limitations and low prioritisation of oral health are the main barriers to good oral health care. The study reveals that such individuals experience greater financial barriers and poorer access to a dentist than to a general medical practitioner. The study also reveals that dentists report financial concerns and administrative burdens as the main barriers in treating this subgroup. The responses of PCSWs demonstrate that local dentists are reluctant to treat this subgroup. CONCLUSION Additional efforts are needed to improve the accessibility of oral health care for people on social assistance. Recommended improvements at the organisational level could improve increased education to target the population on the importance of oral health care. Administrative burden and financial concerns of the providers also need to be addressed to decrease their reluctance to work with those on social assistance.

Treatment needs and therapy experiences in patients with temporomandibular disorders: a retrospective survey

Abstract Objectives: This study investigated a patient population suffering from temporomandibular disorders (TMD) with respect to their need for treatment, satisfaction with the information received, and the treatment provided. Methods: A survey was sent by post to 1011 patients. Results: Almost one-third of the patients had used analgesics prior to the start of any treatment. Having pain and functional jaw complaints was a risk factor for patients experiencing social restrictions. Subjects with severe complaints needed a range of conservative treatment modalities in combination with more follow-up appointments in agreement with the practitioners. Persons with remaining functional limitations were often unsatisfied with information and care they had received. The rate of compliance with prescribed treatment modalities and advice corresponded significantly higher with patient contentment with final outcome. Discussion: Patient satisfaction is often determined by a qualitative doctor–patient relationship. The influence of complaints and pain on daily functioning was illustrated. Pain medication use at baseline seems to be predictive for persistent orofacial pain (OFP).