Adult Oral Health

The purpose of this article is to describe several complex vascular access procedures and the outcomes achieved with them in 24 patients (mean age 60 years) undergoing hemodialysis in whom all other accesses had failed and neither peritoneal dialysis nor transplantation was possible. Patients underwent either a necklace bypass (n = 5), axillary loop (n = 1), contralateral internal jugular vein bypass (n = 6), femorofemoral crossover bypass (n = 1), superficial femoral vein transposition (n = 5), axillary artery to popliteal vein bypass (n = 5), or femoral artery to right atrium bypass (n = 1). All grafts implanted were 6 mm, internally reinforced prostheses made of expanded polytetrafluoroethylene (Gore-Tex Intering Vascular Graft). Postoperatively patients had bimonthly clinical examinations in which the thrill, bruit, skin, cannulation sites, and adequacy of dialysis were reviewed. A bimonthly ultrasound dilution assessment that included estimation of the graft inflow rate, recirculation rate, and cardiac output was also performed. There was one serious postoperative complication: rapid-onset severe steal syndrome that required immediate tie off of the fistula. During the median follow-up time of 22 months, three patients died of causes unrelated to their vascular access. Nineteen dilatations and 10 surgical revisions were done. Primary patency rates were 83%, 63.5%, and 63.5%, respectively, at 6 months, 1 year, and 2 years; secondary patency rates were 91%, 77%, and 77%. Complex vascular access procedures can provide patients some additional good-quality time on hemodialysis.

To determine first year dental students' perceptions of intimidation by instructors and bullying by fellow students. Data were collected through a cross-sectional survey of first year dental students from seven dental schools representing five countries; one each from Romania, South Africa, Australia and the U.S.A., and three from Malaysia. Self-report questionnaires were administered to participants at least six months after they had commenced their dental degree course during 2005-6. Over a third (34.6%) reported that they had been intimidated or badly treated by their tutors/instructors and 17% reported that they had been bullied or badly treated by their fellow students in the recent past. There were statistically significant differences in reports of intimidation by instructors between the different dental schools. Intimidation by instructors was associated with a history of medication use for stress, anxiety and depression, and perceived stress in the past month. There wer...

Aim: To carry out a field study of the oral health status, and evaluate the treatment needs of subjects with multiple disabilities in a long term residential care setting “Recuperation and rehabilitee centre for persons with handicap” (CRRPH) in Bucharest, Romania. Design: All residents were included in the study. Clinical examinations were based on the World Health Organisation criteria for field studies and carried out in the dental clinic of the residential centre, in dormitories or outdoors. Oral hygiene, mineralisation disturbances, dental and periodontal status were evaluated. Results: 155 patients (85 males and 70 females) in CRRPH were examined. The average age of the residents was 21.5 years. The patient compliance was evaluated as good (99%) despite dental fear in many cases. Twenty five per cent of the residents had a full dentition, three were edentulous or only had roots remaining and seven still had their primary teeth. The results showed a mean DMFT of 6.4. The number...

To determine first year dental students' perceptions of intimidation by instructors and bullying by fellow students. Data were collected through a cross-sectional survey of first year dental students from seven dental schools representing five countries; one each from Romania, South Africa, Australia and the U.S.A., and three from Malaysia. Self-report questionnaires were administered to participants at least six months after they had commenced their dental degree course during 2005-6. Over a third (34.6%) reported that they had been intimidated or badly treated by their tutors/instructors and 17% reported that they had been bullied or badly treated by their fellow students in the recent past. There were statistically significant differences in reports of intimidation by instructors between the different dental schools. Intimidation by instructors was associated with a history of medication use for stress, anxiety and depression, and perceived stress in the past month. There wer...

UNLABELLED New radiographic maxillofacial techniques, cone beam computerized tomography (CBCT) are a necessity in the assessment of jaw bone offer to effectively evaluate the treatment. AIM To quantitatively and qualitatively evaluate anterior mandibular area on CBCT comparing to orthopantomography (OPG). MATERIAL AND METHODS Fifty-one dental patients, aged between 20 and 77 years, were quantitatively analyzed and 81 dental patients, aged between 20 and 79 years, were qualitatively analyzed. ANOVA and Mann-Whitney tests were used for statistical analyses. RESULTS Strong statistical significant differences were recorded between CBCT and OPG assessments for all groups of teeth (p<0.001), when evaluation was performed on distances to mandibular base. When assessing the distance to the incisive canal, the differences were recorded only for the left canine zone. Mean densities of central incisor, lateral incisor and canine regions, were 1,400-1,425 HU, 1,212-1,224 HU, and 1,150-1,175 ...

Recent studies have attempted to determine the prevalence of dentine hypersensitivity (DH) in both hospital and general practice. Results indicate that DH prevalence is higher in patients referred for specialist treatment than in general practice. The aim of this study was to determine perception and prevalence of DH in general practice. Completed questionnaires from 277 patients (115 males, 162 females, mean age 41·7 years [SD 14·36]) were collected. Self-reported DH prevalence (52%) was observed between the third and fourth decades, peaking in the third and in good agreement with that previously published (45·2%), and significantly more females complained of DH than males (SND=2·24, 95% CI 0·01734–0·2661). Cold was perceived as the most common cause of DH, in agreement with other studies. Only 12·6% of patients reported periodontal surgery compared to 15·5% previously. Of those who received hygiene therapy (67·9%) only 15·5% reported DH following treatment which mainly did not last ≥5 days. Most patients with DH did not perceive the condition as severe and did not seek treatment (75·1%). Only 23·3% used a desensitizing dentifrice. The results indicated that self-reporting of DH is lower than reported in a dental hospital population and was not perceived as a major dental problem by most patients in a general dental practice population.

Dentine sensitivity (DS) is a common condition which affects 8–35% of the population. Both In-Office and Over-the-Counter products have been used in treatment, usually occluding open dentine tubules on the exposed root surface. Currently there appears to be no ideal material which permanently occludes dentine tubules. Bioactive and biocompatible glasses are known to induce osteogenesis in physiological systems and may offer suitable materials for surface reactivity which could theoretically occlude tubules. A new dentifrice formulation containing a modified Bioglass® material replacing part of the abrasive silica component was compared with original 45S6 bioactive glass. Dentine discs were treated with original Bioglass®, three coded dentifrices containing 0, 2·5 and 7·5% Bioglass® and two further selected dentifrice products. These specimens were prepared for scanning electron microscopy (SEM) and viewed in a Cambridge stereoscan 90B. The results demonstrated that original bioactive glass particles covered the dentine surface and/or occluded dentine tubules, although this original formulation was easily dislodged. Dentifrice with different ratios of added Bioglass® was assessed to provide greater surface coverage and tubule occlusion than without Bioglass®. It was concluded that the inclusion of bioactive glass particles in a suitably formulated vehicle may be an effective agent for the treatment of dentine sensitivity.

Epidemiological data on dentine hypersensitivity (DH) prevalence are limited. Few studies have compared prevalence between populations. The aim of this investigation, therefore, was to compare the perception and prevalence of DH in two distinct non-periodontal practice populations, one U.K. and one Korean. Completed questionnaires from 557 patients (230 males and 327 females, comprising 115 males and 162 females, mean age 41·7 years (s.d.=14·36), U.K. and 115 males and 165 females, mean age 29·7 years (s.d.=11·86), Korean) were collected. Analysis was by frequency distribution and cross-tabulation (Statistical Package for the Social Sciences (SPSS)). DH prevalence was similar and at levels comparable with those reported previously. Prevalence was higher in the third and fourth decades in both populations. Although there were no differences between U.K. or Korean males and U.K. or Korean females, there was a significant difference between gender reporting of DH, with more females complaining of DH than males (standard normal deviation (SND)=4·3, 95% confidence interval (CI)=0·1134–0·2736). DH appeared to be regarded by patients as not severe in most cases, so treatment was not generally sought. Of those who claimed to have sought treatment, a significant number had received restorative treatment. Of those patients, only 23·3% of U.K. and ≤2% of Korean patients claimed to have used a desensitizing dentifrice. Pain from DH was reported as low grade (slight, occasional) occurring over 5 years in both populations. Cold appeared to be the most reported stimulus in the two populations. Less periodontal surgery had been undertaken in these two populations (12·6% U.K. and 7·1% Korean) compared with those referred to a teaching hospital periodontal department (34·5%). This compared favourably with previous findings in the general dental population (15·5%). Discomfort following hygiene therapy did not appear to last ≥7 days in either population. The results indicated that there were no significant differences between U.K.- and Korean-based populations in their perception of DH, with the exception that more females complained of sensitivity than males in both groups. Overall, DH was not considered a major dental problem by most patients in either of the populations.

Previous studies have reported on dentine sensitivity (DS) prevalence in hospital and general practice populations. Results from these studies indicate that perception and prevalence of DS vary depending on the population. The study aimed to determine any major differences in the perception and prevalence of DS in subjects in a military training establishment. Questionnaires from 228 subjects [188 completed by males, 39 completed by females, with one person not indicating their gender of mean age 24·0 years (s.d. 7·16)] were collected and analysed using the Statistical Package for the Social Sciences (SPSS). Fifty percent of the subjects (n=114) claimed to have DS. Yet approximately 30% of the subjects (29·8%, n=68) perceived the condition as a slight problem and approximately 40% of the subjects (40·8%, n=93) claimed it was an occasional problem and approximately 50% (49·1%, n=112) did not seek treatment. Seventeen subjects (7·5%) used a desensitizing paste during periods of discomfort. No clear pattern emerged with regard to seasonal variation in DS although 5·7% (n=13) subjects considered DS to be more of a problem in winter. Only 7·9% (n=18) reported any previous periodontal surgery, consistent with previous studies (12·6 and 15·5%). Of those who received regular scaling (27·2%, n=62), only 23 (10·1%) reported any discomfort following treatment, which did not last ≥5 days. The results indicate that self-reporting of DS was similar to previous reports, although it is of fundamental importance that such studies should be supplemented with a thorough clinical examination to determine more reliable prevalence data.

Abstract 2 strontium chloride hexahydrate-containing dentifrices (SCH), similar except for their respective abrasive systems, were compared in a 2–month randomised double-blind parallel clinical study to evaluate their comparative effectiveness in terms of cervical dentinal hypersensitivity. 2 groups of 20 subjects, each with cervical dentinal hypersensitivity, were evaluated for tactile sensitivity by Yeaple probe, air sensitivity using a dental air syringe and subjective perception of pain by means of a visual analogue scale. There was no difference between the dentifrices as regards reduction of cervical dentinal hypersensitivity at each time point. The response to both dentifrices was evident within 4 weeks of use and the degree of improvement increased throughout the 8–week study period. The results support the conclusion that changing the abrasive component of SCH dentifrices did not significantly increase or decrease the (desensitizing) activity of the original product.

The aim of the present investigation was to determine by questionnaire, UK dentists' perception of Dentine Hypersensitivity (DH) and knowledge of its treatment. A total of 403 questionnaires were sent to a selected group of UK dentists who had either inquired about further postgraduate education or had attended a course at the Eastman Dental Institute/Hospital. A total of 181 of 403 dentists (44·9%) (118M; 36F, 17 no response, mean age 38·2 years [s.d. 8·97]) returned the questionnaire. About 92·8% (n=168) of responding dentists claimed to see patients with DH in their practice. According to the dentists' replies at least one of four of their patients suffered from the complaint. About 71·8% (n=130) of dentists reported that DH was a severe problem in at least 10% of their patients and that pain from DH lasted no more than 4 weeks. Most of responding dentists claimed to be asked about DH by their patients and stated that they offered advice or treatment to their patients. Nearly 87·3% (n=158) of responding dentists provided a wide range of treatment options/advice which included both In-office and over-the-counter (OTC) products. Popular responses included desensitizing pastes/gels, Topical F– varnishes and toothpastes/rinses/gels, advice on atraumatic tooth brushing, dentine bonding agents (DBA), glass–ionomer cements (GIC) and other unspecified restorations. Of the various In-office treatments Duraphat was the most cited choice of varnish/primer options. Sensodyne toothpaste was the most popular of the specified OTC products. Most dentists appeared to understand the aetiological features associated with DH and provided a wide range of factors including the effects of incorrect tooth brushing, dietary acids as well as the possible influence on non-dental topics such as stress. Most responding dentists believed that their advice on DH was generally effective although they did highlight that certain aspects on the condition were lacking such as appropriate scientific information including the prevention of DH and its treatment. The results from the present study highlight several discrepancies in the perception and knowledge of the treatment of DH between dentists and their patients. The results from this study are, however, reasonably consistent with those previously reported by Dutch investigators. The results from this study also highlighted a need for guidelines on the aetiology, prevention and treatment of DH for both dentists and their patients. The reported average frequency and duration of discomfort from DH by the responding dentists appeared to be consistent with the available literature.

Relatively few studies have reported on the frequency, distribution and severity of dentine hypersensitivity (DH) in subjects recruited for clinical trials of desensitizing agents. Potential subjects (n= 48 M, 81 F, mean age 35·1 years) for inclusion into such a study were screened to determine the extent of the problem. 117 subjects (41 M, 76 F) mean age 24·9 years were clinically examined. Evaluation by questionnaire indicated that the prevalence of DH was proportionately higher in the 20–29·9 years (34·9%), and 30–39·9 years groups (33·3%), respectively. Sensitivity to cold was the main presenting symptom. Tactile (probe) and cold air (dental air syringe) stimuli were used to clinically evaluate DH. Of the teeth eligible for evaluation 1561/3136 (49·8%) responded to either one or both of the test stimuli; 274/3136 (8·7%) responded to tactile only stimulation, 779/3136 (24·8%) to thermal only stimulation and 508/3136 (16·2%) to both tactile and thermal stimulation. Of those teeth responding to the stimuli, 477 (30·6%) were premolars, 437 (28%) incisors, 415 (26·8%) molars and 232 (14·9%) canines. The results agree with those of previously reported studies in that DH is most frequently observed on premolars and that proportionately more teeth are sensitive to evaporative than to tactile stimulation. Furthermore it would appear from the results of the study that tactile is less effective than thermal/evaporative stimulation in the evaluation of DH.