Richard N. Bohay

A survey of radiographic techniques and equipment used by a sample of general dental practitioners

A study of radiographic practices of general dentists was conducted by mail survey. Eighty percent of 963 dentists returned completed questionnaires. All participants resided in the province of Ontario, Canada, and were graduates of either of the two provincial dental schools. Fewer than one third of radiographs were taken by the dentist with only 10% of dentists taking three fourths or more of the radiographs in their practices. There was infrequent use of E speed film (11%) and rectangular collimation (8%). Automatic processing was used by 93% of dentists. Although the overwhelming majority of dentists used a film holder, 2% still have the patient hold the film. The type of film holder used was affected by dental school experience, whereas the use of E speed film was not.

Effectiveness of antiviral agents for the prevention of recurrent herpes labialis: a systematic review and meta-analysis

OBJECTIVE The purpose of this study was to complete a systematic review and, if possible, a meta-analysis on the effectiveness of systemic and topical nucleoside antiviral agents in the prevention of recurrent herpes labialis (RHL) in immunocompetent subjects. STUDY DESIGN Multiple comprehensive electronic and manual literature searches without language restrictions identified the studies to be included. Quality assessment and data synthesis methods followed those described in the Cochrane guidelines. RESULTS Of 2,683 papers reviewed, 10 met the inclusion criteria. Oral acyclovir (800-1,600 mg daily) and valacyclovir (500 mg daily for 4 months) were shown to be effective in the prevention of RHL when taken prior to the appearance of any symptoms or exposure to triggers. Of the 10 papers reviewed, only 1 was determined to have a low risk of bias. CONCLUSIONS This review found support for the use of systemic acyclovir and valacyclovir for the prevention of RHL.

A survey of the radiographic practices of general dentists for edentulous patients

OBJECTIVE The objective of the study was to evaluate the radiographic practice of general dentists for edentulous patients. STUDY DESIGN A questionnaire was sent to a sample of graduates from the two Ontario dental schools. RESULTS The adjusted response rate for the survey was 80%. Fifty-three percent of the respondents used screening radiography for new patients. The overwhelming choice for these dentists was the panoramic film. There was a significant positive association between ownership of a panoramic unit and use of this radiograph. Dentists who do not own a panoramic unit rarely chose to refer their patients for this radiograph either routinely or selectively. When dentists, rather than the auxiliaries, made the greater proportion of the radiographs, they tended to use selective radiography. Most dentists chose selective radiography for the recall patient. CONCLUSIONS Almost half the dentists did not follow the Food and Drug Administration/American Dental Association guideline of screening radiography for the new edentulous patient. Of those dentists who did follow the guideline the vast majority both owned panoramic units and chose to use a panoramic survey. Most dentists followed the guideline for selective radiography for the recall patient.

Osteopathia striata, short stature, cataracts, and microdontia: A new syndrome? A case report

A case of osteopathia striata, childhood cataracts, short stature, elbow deformity, and microdontia with rhizomicry in a white male is reported. The report includes a detailed analysis of dental changes. The relationship of this syndrome to other similar conditions including osteopathia striata with cranial base sclerosis and Rothmund-Thomson syndrome are discussed.

An analysis of the scientific basis for the radiographic guideline for new edentulous patients

The FDA Radiology Guideline for the new edentulous patient recommends an initial survey of the arches. In the process of developing this recommendation, the expert panel reviewed the available literature and concluded that there was sufficient evidence to warrant screening radiography rather than selective radiography, which is the principle on which all the other recommendations are based. Our evaluation of the literature used by the panel for the edentulous recommendation identifies critical errors in the analysis of the data. Factors such as a vague definition of abnormality and a geographically diverse sample population might have led the expert panel to suggest a very conservative recommendation for this group of patients. The recommendation failed to consider the treatment impact of findings and was based simply on the large number of observations, regardless of their treatment or pathologic significance. However, in studies in which treatment is considered, it is clear that screening radiography for new edentulous patients does not yield sufficient clinically relevant information to support the guideline.

The Effectiveness of Noninvasive Interventions for Temporomandibular Disorders: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

Objective:To determine the effectiveness and cost-effectiveness of noninvasive interventions for temporomandibular disorders (TMD). Methods:We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central register from 1990 to 2014 for effectiveness studies and the Cochrane Health Technology Assessment Database, EconLit, NHS Economic Evaluation Database, and Tufts Medical Center Cost-Effectiveness Analysis Register from 1990 to 2014 for cost-effectiveness studies. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Evidence from eligible studies was synthesized using best-evidence synthesis methodology. Results:Our search for effectiveness studies yielded 16,995 citations; 31 were relevant and 7 randomized controlled trials (published in 8 articles) had a low risk of bias. We found no relevant cost-effectiveness studies. The evidence suggests that for persistent TMD: (1) cognitive-behavioral therapy and self-care management lead to similar improvements in pain and disability but cognitive-behavioral therapy is more effective for activity interference and depressive symptoms; (2) cognitive-behavioral therapy combined with usual treatment provides short-term benefits in pain and ability to control pain compared with usual treatment alone; (3) intraoral myofascial therapy may reduce pain and improve jaw opening; and (4) structured self-care management may be more effective than usual treatment. The evidence suggests that occlusal devices may not be effective in reducing pain and improving motion for TMD of variable duration. Evidence on the effectiveness of biofeedback is inconclusive. Discussion:The available evidence suggests that cognitive-behavioral therapy, intraoral myofascial therapy, and self-care management are therapeutic options for persistent TMD.

A study of the impact of screening or selective radiography on the treatment and postdelivery outcome for edentulous patients

OBJECTIVE The purpose of this study was to assess the impact of radiographic findings on complete denture treatment and on the postdelivery course of those patients who had pretreatment radiographs (the screening group) and those who did not (the selection group). METHOD In total, 375 cases were randomly selected by systematic sampling. Data collected included patient demographic information and denture history, predenture fabrication radiographic findings, and postdenture delivery complaints. RESULTS Of the screening patients, 100% had pretreatment radiographs made; this compared with 13.5% of the selection patients. In the screening group, 68.3% of patients had one or more positive radiographic findings recorded. Of the screening patients, 8.3% received treatment before denture fabrication; this compared with 1.2% of the selection patients. Of the 375 cases, 2 screening patients had postdelivery complaints that required management other than denture adjustment. CONCLUSION The results indicate that there is weak scientific support for the guideline recommending routine pretreatment radiography for new denture patients.

Angiogenic Rg1 /Sr-Doped TiO2 Nanowire/Poly(Propylene Fumarate) Bone Cement Composites.

A new approach is provided for preparing radiopaque and angiogenic poly(propylene fumarate) (PPF) bone cements by integrating Sr-doped n-TiO2 nanowires and ginsenoside Rg1 suitable for treating osteonecrosis. High aspect ratio radiopaque TiO2 -nanowires are synthesized by strontium doping in supercritical CO2 for the first time, showing a new phase, SrTiO3 . PPF is synthesized using a transesterification method by reacting diethyl fumarate and propylene glycol, then functionalized using maleic anhydride to produce terminal carboxyl groups, which are subsequently linked to the nanowires. The strong interfacial adhesion between functionalized PPF and nanowires is examined by scanning electron microscopy, Fourier transform infrared, X-ray photoelectron spectroscopy, thermal analysis, and mechanical testing. An angiogenic modulator, ginsenoside Rg1 , is integrated into the bone cement formulation with the mechanical properties, radiopacity, drug release, and angiogenesis behavior of the formed composites explored. The results show superior radiopacity and excellent release of ginsenoside Rg1 in vitro, as well as a dose-dependent increase in the branching point numbers. The present study suggests this new methodology provides sufficient mechanical properties, radiopacity, and angiogenic activity to be suitable for cementation of necrotic bone.

Diagnostic Paleoradiologyfor Paleopathologists

Paleopathology is the study of ancient disease processes in skeletal remains using a spectrum of methods consisting of gross observation and radiological, paleohistopathological, biochemical, isotope, and DNA studies. Each of these tests carries both advantages and limitations, and almost all require the irreversible destruction of the specimen. In contrast, x-ray study is an appealing option because it can be performed without any significant damage to the specimen. According to Ragsdale, “Radiographs can be thought of as gross photographs of whole lesions and contribute much toward the orthopedic pathologist’s goal of understanding the origin, structure, and mechanism of skeletal diseases”, and “Maceration of residual gross material produces bone specimens that match radiographs precisely and are relevant to other fields, for example paleopathology…” (Chhem 2006; Ragsdale 1993). This underlines the important role of specimen radiological studies in both clinical and paleopathological investigations. Whether the radiation causes any alteration of the genetic materials of the specimen has yet to be documented scientifically.