A preliminary evaluation of pre-treatment hypodontia patients using the Dental Aesthetic Index: how does it compare with other commonly used indices?

There is currently no specific occlusal index related to hypodontia and there is a paucity of published literature on this subject. The aim of this study was to determine the relationship, if any, between the Peer Assessment Rating (PAR) Index, the Index of Complexity, Outcome and Need (ICON), and the Dental Aesthetic Index (DAI) score and the severity of hypodontia. All new patients attending the Newcastle Dental Hospital hypodontia clinic between February 2002 and March 2003 were included in the study. Of the 60 patients, two were excluded as the models were unavailable and one because they were predominantly in the primary dentition, making scoring impractical. The patient casts were scored with respect to PAR, ICON, and DAI. The mean patient age at presentation was 12 years, with a standard deviation of 1.89 and a range of 9-16 years, and a female to male ratio of 1.1:1. A significant positive correlation, using Kendall tau b, was found between the number of missing teeth, excluding third molars, and the DAI score (tau = 0.215, P = 0.027). There was no significant positive correlation between PAR (tau = -0.186, P = 0.056) and ICON (tau = 0.017, P = 0.861) score and the number of missing teeth. The results of this investigation indicate that further research is required in order to assess if the DAI could be used to determine whether or not to refer hypodontia patients for specialist advice.

Quality assurance and benchmarking: an approach for European dental schools

This document was written by Task Force 3 of DentEd III, which is a European Union funded Thematic Network working under the auspices of the Association for Dental Education in Europe (ADEE). It provides a guide to assist in the harmonisation of Dental Education Quality Assurance (QA) systems across the European Higher Education Area (EHEA). There is reference to the work, thus far, of DentEd, DentEd Evolves, DentEd III and the ADEE as they strive to assist the convergence of standards in dental education; obviously QA and benchmarking has an important part to play in the European HE response to the Bologna Process. Definitions of Quality, Quality Assurance, Quality Management and Quality Improvement are given and put into the context of dental education. The possible process and framework for Quality Assurance are outlined and some basic guidelines/recommendations suggested. It is recognised that Quality Assurance in Dental Schools has to co-exist as part of established Quality Assurance systems within faculties and universities, and that Schools also may have to comply with existing local or national systems. Perhaps of greatest importance are the 14 'requirements' for the Quality Assurance of Dental Education in Europe. These, together with the document and its appendices, were unanimously supported by the ADEE at its General Assembly in 2006. As there must be more than one road to achieve a convergence or harmonisation standard, a number of appendices are made available on the ADEE website. These provide a series of 'toolkits' from which schools can 'pick and choose' to assist them in developing QA systems appropriate to their own environment. Validated contributions and examples continue to be most welcome from all members of the European dental community for inclusion at this website. It is realised that not all schools will be able to achieve all of these requirements immediately, by definition, successful harmonisation is a process that will take time. At the end of the DentEd III project, ADEE will continue to support the progress of all schools in Europe towards these aims.

Tutor perceptions of the use of a reflective portfolio within a pastoral tutor system to facilitate undergraduate personal development planning

All Higher Education Institutions in the UK are now required to provide transcripts of student activity and outcomes of summative assessments. In addition, the student should be able to reflect on their learning and plan their own development. This article reports on the staff evaluation of the use of a reflective portfolio facilitating the production of highly individualised personal development plans within an existing tutor system. A number of significant issues are highlighted; tutor systems adopting this approach must maintain flexibility for managing student crises when they arise, the difference between appraisal and assessment needs clear definition for both students and tutors, training in basic mentoring skills should be provided for all tutors, tutors should be aware of the difficulties many students experience with reflection and also be alert to the over reflective learner.

Severe hypodontia in a set of triplets

Hypodontia is the developmental absence of one or more teeth from the dentition and constitutes one of the most common developmental anomalies in humans with a reported prevalence of 1.6 to 9.6% in the permanent dentition. Hypodontia may occur in association with other genetic diseases, or as an isolated familial or sporadic form. This article describes the rare phenomenon of severe hypodontia in a set of triplets. The triplets presented with congenital absence of the second molars, second premolars in all quadrants and lower central incisors. An additional five teeth (upper canines, upper lateral incisors and upper left first premolar) were missing in one of the triplets. The treatment plan and the possible genetic mode of inheritance are discussed.

A quantitative study of enamel acid etch patterns on surfaces used for retention of resin-bonded fixed prostheses

This study investigated the quality of in vivo etch patterns on the bonding surfaces of 46 abutment teeth following acid etching with 37% phosphoric acid for 30 seconds. Two-stage putty and light bodied addition cured silicone impressions of the etched lingual surfaces were used to form replicas that were then viewed using the scanning electron microscope. Over 69% of the lingual bonding surface area of incisors, canine and premolars were unetched, 16% barely etched, 7% etched and less than 2% ideally etched. There was no significant difference in the quality of etch between different tooth types. There was a significantly greater proportion of poorly etched enamel towards the cervical margin in comparison with the occlusal half. This may have implications in retention of resin bonded bridges.

Orthodontic management of orofacial problems in young people with impairments: review of the literature and case reports

OBJECTIVE

The aim of this paper is to present a series of cases illustrating possible options for the management of malocclusions in a group of young people with impairments. Design. The study took the form of a case series.

METHODS

A review of the literature is presented and a series of illustrative cases are shown to indicate that orthodontic treatment is possible in patients with a range of impairments.

RESULTS

Five children with varying intellectual and/or physical impairments, and a malocclusion that resulted in trauma or increased disability, are presented.

CONCLUSION

The risks and benefits of the procedures, and the anticipated oral health outcomes, need to be considered carefully in this group of children.

Undergraduate orthodontic teaching in the new millennium--the Newcastle model

This paper identifies the main factors which have influenced the nature of the undergraduate orthodontic curriculum presently taught at Newcastle University. It also outlines the philosophy that underpins the teaching, states the professional aims of the tutors and spells out the clinical objectives set for the students.

The interdisciplinary management of hypodontia: the relationship between an interdisciplinary team and the general dental practitioner

This paper will illustrate how the general dental practitioner can provide care for patients with hypodontia. It will demonstrate how an interdisciplinary team works for hypodontia patients and, in particular, for those with severe hypodontia.

The role of magnets in the management of unerupted teeth in children and adolescents

This case report describes the use of magnets in the management of teeth that fail to erupt. Eight children aged between 10 and 15 years were treated. Magnetic traction was applied to two premolars and six molars. Seven teeth (one premolar and six molars) erupted successfully (mean treatment time with magnetic traction: 7.5 months). One premolar failed to erupt; serial radiographic assessment over a 9-month period revealed no evidence of movement and so the magnetic fixture was removed. Histological evaluation of tissue samples taken from around the fixture revealed no evidence of abnormal pathology.

The interdisciplinary management of hypodontia: restorative dentistry

This paper considers the role of restorative dentistry in the management of hypodontia. The paper describes the general restorative considerations common to patients with hypodontia and illustrates the variety of restorative techniques available in the restorative management of hypodontia and oligodontia.

The interdisciplinary management of hypodontia: background and role of paediatric dentistry

This paper is the first of a series on the comprehensive management of young people with hypodontia. The paper looks at the background to the condition, the possible aetiological factors, the prevalence of hypodontia and other related conditions. Lastly there is consideration of the role of the paediatric dentist in interdisciplinary management of the affected child and adolescent patient.

Acid-etch patterns on the buccal surface of human permanent teeth

Since the introduction of acid etching to aid adhesion to enamel, there has been much research into dental materials to improve bond strength, but little into the surface topography of etched enamel, particularly regarding possible variations between tooth types. This study was a systematic investigation into the quality and quantity of etch patterns found on the buccal surfaces of different human permanent teeth. Twenty-nine orthodontic patients had high-resolution silicone impressions taken of the buccal surface of incisor, canine, premolar and molar, upper and lower teeth, following etching for 30s with 37% phosphoric acid. Impressions (n=266) were replicated in epoxy resin and examined under high magnification in a scanning electron microscope. A modification of the classification of Galil and Wright was used, with histometric techniques, to quantify the quality of etch patterns on enamel surfaces where orthodontic brackets are typically bonded. There was no difference between right and left or between upper and lower teeth of the same type (P>0.05). There was a general trend toward the increasing occurrence of no etch (type D) from anterior to posterior teeth, and a trend toward fewer good-quality etches (types A and B) in the same direction. Etch types A and B were found to occupy the smallest area on the etched buccal surface enamel. The greatest amount of type A etch 'ideal' was found on the lower incisors, yet it occupied less than 5% of the etched buccal surface enamel. The greatest area of etched enamel surface was occupied by type C (etched, but enamel prisms not evident). It was concluded that there is a significant difference in the acid-etch patterns achieved on different tooth types, which suggests that bond-strength studies should be performed with a single tooth type or that an equal number of different tooth types be included.

Relationship between enamel etch characteristics and resin-enamel bond strength

OBJECTIVES

The aim of the study was to investigate the relationship between etch patterns produced on surface enamel by phosphoric acid and the corresponding bond strengths achieved.

MATERIALS AND METHODS

Twenty-eight patients had the buccal surface of their teeth etched and replicated for examination under the scanning electron microscope, at the commencement of orthodontic treatment. Histometry was employed to assess the nature and quality of etch patterns using a four-point scale. Twenty of each tooth type (total of 240), were collected and A Company pre-adjusted orthodontic brackets, bonded using Transbond light-cured orthodontic adhesive according to the manufacturer's instructions and 24-hour bond strength testing was undertaken. The Adhesive Remnant Index (ARI) was recorded for the tooth and bracket surface for all specimens.

RESULTS

The type of etch was not significantly affected by the side (left or right) of the mouth assessed (p = 0.532). Overall, there was no significant difference between etch types for upper and lower teeth (p = 0.218); however, there were significant differences between specific teeth in the upper and lower arch. The greatest amount of Type A etch (well-defined etched enamel prisms) was found on the lower incisors, yet in all cases this 'ideal' etch was found to occupy less than 5% of the etched buccal surface enamel. The greatest area of etched enamel surface was occupied by Type C (etched but enamel prisms not evident). The mean bond strength values varied significantly between different tooth types, with the lowest bond strength found on the upper first molar(6.5MPa) and the highest on the lower first molar (13.1 MPa).

CONCLUSIONS

An ideal etch pattern is not essential in order to produce a strong bond.

The effect of moisture and blood contamination on bond strength of a new orthodontic bonding material

The practice of orthodontics often requires the bonding of brackets under difficult conditions of moisture and/or blood contamination. Transbond MIP (3M Unitek, Monrovia, Calif) is a hydrophilic primer designed to bond in moist conditions. This study evaluated the bond strength of Transbond MIP under dry, moist, and blood-contaminated conditions. Ninety human premolars were bonded in 3 equal groups with Transbond MIP after acid etching; the enamel surfaces were either dry, moist, or contaminated with human blood. The shear bond strength was recorded. Dry bonding resulted in a significantly higher bond strength (15.69 MPa) than moist (12.89 MPa) or blood-contaminated (11.16 MPa) bonds. However, all bond strengths were in excess of previous reports of required clinical bond strength, and it was concluded that Transbond MIP is a suitable adhesive for bonding in conditions of poor moisture control or blood contamination.

Evaluation of a computer-assisted learning programme on the oro-facial signs of child physical abuse (non-accidental injury) by general dental practitioners

A computer-assisted learning programme with tutorials and self assessment multiple choice questions has been developed. One hundred and two general dental practitioners were asked to evaluate the programme. Over 80% of respondents felt that the programme was easy to use, contained an appropriate level of supporting information, and had improved their knowledge of non-accidental injury. All users of the programme felt that it was a better way of learning than video, audio tapes, and journals or books on the subject. It is concluded that CAL programmes are worthwhile for providing continuing professional education for general dental practitioners.

Dental evaluation of scuba diving mouthpieces using a subject assessment index and radiological analysis of jaw position

OBJECTIVE

To compare two experimental scuba mouthpieces with a commercially available design.

METHODS

A laboratory study using six men to assess effort, muscle pain, muscle fatigue, facial discomfort, tooth discomfort, and loss of lip sensation using a visual analogue scale. Cephalometric radiographs and analysis of jaw position with each mouth piece were also used.

RESULTS

Fully customised mouthpieces caused the least discomfort, muscle pain, fatigue, and effort. They also resulted in the least mandibular displacement from the resting position. Radiographic analysis of jaw position showed that the fully customised design resulted in the least displacement from normal jaw position.

CONCLUSIONS

A fully customised design gives the greatest comfort, least effort, and least mandibular displacement. This design is recommended, particularly for divers who experience temporomandibular dysfunction associated with diving.

Bond strength to surface enamel for different tooth types

OBJECTIVES

Fixed appliance therapy in orthodontics relies on the effective bonding of brackets to surface enamel. Bracket de-bonding during treatment is both inconvenient and costly to both dentist and patient. Factors which control the efficacy of the bond are not fully understood. For example, there has never been a study to determine the efficacy of bonding to different teeth in the dentition. The aim of this study was to investigate the possible differences in bond strength to acid etched enamel on the different teeth of the dentition.

METHODS

Two hundred and forty extracted sound human teeth were collected from white Caucasian subjects between the age of 10 and 22 years. Approximately 20 teeth of each tooth type were bonded using a standard acid etch technique with 'A company' stainless steel brackets using a light cured composite (Transbond, 3M Unitek). Shear bond strength (24 h) was measured using an Instron testing machine.

RESULTS

Tooth type was found to have a significant effect on bond strength (p<0.001). The greatest mean bond strength was found on the lower first molar teeth, and the lowest on the upper first molar teeth. In the upper arch, bond strength was greater on anterior teeth than posterior teeth (p<0.001). In the lower arch bond strength was weaker on anterior teeth than posterior teeth (p<0.001).

SIGNIFICANCE

The results have profound implications for bond strength testing of dental composites to enamel as well as to the expectations of bond reliability in orthodontic therapy. The findings suggest that, in order to achieve meaningful comparisons, enamel bond strength measurements should be made using the same tooth type, or that appropriate stratification of groups of test teeth should be used. These findings may also explain, in part, variability in enamel bonding efficacy despite the best efforts of the dental practitioner.

An analysis of the skeletal relationships in a group of young people with hypodontia

The objective of this investigation was to examine the dentofacial features of a group of patients with hypodontia, in particular assessing whether cephalometric analysis confirmed the clinical assumption of a reduced lower face height, and to determine the relationship of these facial features with different numbers of missing teeth. It took the form of a cephalometric study, undertaken in a dedicated Dental Hospital clinic for patients with hypodontia. The study group comprised 59 patients seen on the Hypodontia Clinic: 32 females, 27 males, mean age 13.1+/-3.1 years (range 6-23 years). The average number of missing teeth was 7 (SD 5), ranging from 1 to 21. The mean SNA, SNB, and MMA angles were within normal limits, but there was a statistically significant reduction in the MMA when more than one tooth type was missing (P = 0.007) and the ANB angle decreased as the number of missing tooth types increased (P = 0.034). The mean values for the whole sample were within the normal range and did not demonstrate any feature specific to the group, but patients with more severe hypodontia showed tendencies to a Class III skeletal relationship and a reduced maxillary-mandibular planes angle.

A comparative micro-topographic study of the buccal enamel of different tooth types

The aim of this study was to perform an in vitro examination of the etch pattern achieved on the orthodontic bonding area (OBA) of different tooth types, and to compare the extent and definition of etch achieved. Six examples of each permanent human tooth type were studied. These were collected from adolescents. A standardized etch regime was employed on the OBA and the etch pattern examined under the scanning electron microscope. The degree of definition of etch achieved on every third enamel prism was evaluated. Results showed that the extent of etch achieved decreased toward the distal end of each arch and was significantly less on the first molars (covering <2% OBA) than on the incisors (covering >90% OBA). It was also noted that the degree of definition became poorer towards the distal end of the arches and was worst on the mandibular molars. It is suggested that the etched enamel morphology of different tooth types could affect composite resin bond strengths. Consequently, this feature could effect the clinical survival of orthodontic brackets and contribute to the higher failure rate of brackets on posterior teeth.

The effect of food simulants on enamel-composite bond strength

The effect of food simulants upon the enamel-composite bond strength of two orthodontic adhesive composites was studied. Thirty extracted premolars were used in each experimental group. Orthodontic brackets were bonded with either Transbond (3M Unitek) or Right-On (TP orthodontics) and were then exposed to either distilled water (control), 8 per cent ethanol (aqueous food), 50 per cent ethanol (alcoholic food), buffered lactic acid pH4 (acidic food), or corn oil (fatty food) for 12 weeks. Bond strength and Adhesive Remnant Index was recorded. It was found that 50 per cent ethanol had a significant effect upon the bond strength of both Transbond and Right-On. Right-On was affected to a greater extent. The clinical significance of this finding is that alcoholic mouth rinses, and alcohol-containing foods and drinks may be a causative factor in bond failure. However, the use of an alcoholic mouthrinse late in treatment may aid bracket removal. This potential use requires more research. Refereed Scientific Paper

Evaluation of a computer-assisted learning package on the management of traumatised incisors by general dental practitioners

A computer-assisted learning program with a tutorial, self-assessment exercises and an expert system has been developed. Sixty-seven general dental practitioners were requested to evaluate the program. The results from those practitioners who returned the questionnaire showed that 57% found the program generally easy to use with the appropriate level of difficulty of tasks and content of supporting information, which it was felt improved their knowledge of the management of fractured incisors.

CONCLUSION

It is worthwhile to develop such programs for the education of general dental practitioners. All users of this program felt that it was better than video, audio tapes, journals or books on the subject.

Autotransplantation as a treatment option after loss of a maxillary permanent incisor tooth. A case report

A case is described of the management of a maxillary left permanent incisor, damaged by several traumatic injuries, in a 13-year-old girl. The traumatized incisor tooth required extraction and as part of an orthodontic treatment plan, a mandibular left second premolar was surgically transplanted to the prepared extraction socket at the maxillary anterior alveolus. After splinting, the transplanted tooth underwent endodontic treatment, because of pulpal necrosis. Orthodontic treatment commenced 3 months post-transplantation. Permanent root obturation was provided after orthodontic treatment and a porcelain veneer was placed to restore aesthetic appearance. The case emphasizes the importance of correct case selection, a multidisciplinary approach to treatment planning, and regular follow-up for transplanted teeth.

A pilot study of mineralization distribution in the cortical bone of the human mandible

Twenty-three specimens from immediately anteroinferior to the mental foramen were obtained from male and female, dentate and edentate, human mandibles. Planoparallel 80 microm thick sections were prepared from the mandibular specimens and computerized quantitative microradiography undertaken, which allowed the production of mineralization frequency distribution curves and mean mineralization. No differences in mean mineralization with age, sex, presence or absence of dentition were found, but mineralization distribution curves indicated differences between males and females. Within the age range and small sample size examined (40-90 years) there were no age-related differences. There was a lower level of mineralization distribution in the edentulous than the dentate mandible.

Posttreatment assessment of surgically exposed and orthodontically aligned impacted maxillary canines

The records of 96 consecutively treated patients, with a total of 110 exposed maxillary canines, were reviewed after orthodontic alignment of the exposed teeth. In view of the high degree of clinical and patient satisfaction with the results, a random sample of 25 patients, with a total of 30 exposed canines, were critically assessed. The assessment involved scoring for clinical impression, mobility, gingival condition and pocketing, oral hygiene, vitality, and radiographic appearances. The results indicate that the technique of surgical exposure and orthodontic alignment of ectopic maxillary canines provides a satisfactory method of treatment.

How UK orthodontists advise patients on oral hygiene

In 1993, 1038 UK orthodontists (all the members of the British Association of Orthodontists and the British Society for the Study of Orthodontics) were asked by questionnaire about the oral hygiene advice they gave to patients undergoing routine orthodontic treatment. All the orthodontists gave advice on tooth brushing. Most (89.5 per cent) gave dietary advice and (84 per cent) used disclosing tablets. A fluoride rinse was recommended by 73 per cent and a chlorhexidine mouthwash by 41.9 per cent. Many orthodontists advocate appropriate oral hygiene measures, but the efficacy of such methods is determined by the patient's motivation. The orthodontist therefore requires skills in behavioural management. Oral hygiene measures may be more cost-effective when undertaken by trained auxiliaries.

Preliminary quantitative microradiography study into the distribution of bone mineralization within the basal bone of the human edentulous mandible

Six edentulous human hemimandibles (three male, three female) of similar ages were sectioned transversely at the midline, mental foramen, midway between mental foramen and angle (body), and angle of the mandible. Planoparallel sections were prepared of the cortical plate on buccal and lingual surfaces and microradiographed alongside an aluminium step-wedge for computerized quantitative microradiography. Mean mineralization values and mineralization frequency distribution curves were calculated. Gender had no effect on the mean mineralization values, but did show a significant difference in the mineralization frequency distribution. There was no difference in mean mineralization between lingual and buccal cortical plates, but the distribution curves differed, with the lingual cortex distributions being more uniform. Each sample site was significantly different from all others, with the mental foramen and body sites showing the greatest variation in distribution of mineralization level.

Perception of stimulus size in patients with burning mouth syndrome

Twenty subjects with burning mouth syndrome (BMS) and 20 control subjects were tested for oral size perception. Blindfolded subjects assessed the size of holes (2.38-12.70 mm diameter) presented to the tongue, using their fingers to select a matching hole from a comparator series of 31 holes (0.76-15.87 mm diameter) using first static then phasic touch. Both groups overestimated the size of the holes less than 10 mm in diameter but no systematic disparity was evident with holes greater than 10 mm in diameter. The relationship between the stimulus size and the illusion (expressed as the ratio of apparent size to real size) was hyperbolic, with the illusion tending towards unity for holes greater than 10 mm. No differences were found in object size perception amongst patients with BMS or control subjects. It is therefore unlikely that altered oral size perception is a precipitating factor or accompanying feature in patients with BMS.

Airway efficiency during the use of SCUBA diving mouthpieces

OBJECTIVE

To investigate the effect of varying interdental bite platform thickness of the scuba mouthpiece on airway efficiency.

METHODS

10 male divers had their mean peak flow measured for free breathing, maximum flow with diving mouthpiece, teeth in occlusion, and for five experimental mouthpieces with different thickness of interdental bite platform (1 mm, 2 mm, 3 mm, 4 mm, and 5 mm).

RESULTS

The connecting airway between the demand valve and mouthpiece was found to be a major limiting factor in airway efficiency. An interdental bite platform of 4 mm resulted in the greatest air flow with a further increase in thickness resulting in air flow restriction.

CONCLUSIONS

The use of an interdental bite platform of 4 mm placed between the premolar and molar teeth ensures the greatest airway efficiency and also results in a design which provides the least temporomandibular joint discomfort for the diver.

A combined obturator and expansion appliance for use in patients with patent oral-nasal fistula

A combined obturator and expansion appliance design is described for use in patients with patent oronasal fistulae. This is helpful in cleft palate cases, where small fistulae may increase in size during orthodontic expansion of the upper arch, resulting in increased hypernasality of speech and nasal escape.

The design and construction of customised mouthpieces for subaqua diving

Previous studies have shown that many subaqua divers suffer from temporomandibular joint dysfunction and related problems associated with the use of commercially available diving mouthpieces. This paper highlights factors which play a role in the development of these problems, defines essential features required in mouthpiece design and describes a technique for the construction of a fully customized mouthpiece.

Management of the orthodontic patient 'at risk' from infective endocarditis

There are no clear guidelines for the application of current antibiotic prophylactic regimes to orthodontic patients at risk from infective endocarditis. In order to ascertain current practice, a survey on various aspects of the management of orthodontic patients at risk from infective endocarditis was undertaken. Questionnaires were sent to all 1038 members of the British Society for the Study of Orthodontics and the British Association of Orthodontists. A total of 518 replies were received, 480 (46%) of which were completed in full and analysed. Eight cases of infective endocarditis associated with orthodontic treatment over a 44-year period were reported. The majority of respondents underestimated the number of at risk patients likely to be encountered over a 5-year period. Most orthodontists routinely contact the medical practitioner (62%) or hospital consultant (65%) for advice on the prescription of prophylactic antibiotics. Only 58 (12%) claimed to have refused orthodontic treatment for at risk patients. The majority of respondents advise the use of antibiotic prophylaxis for band placement and removal and manipulation of an unerupted tooth. A high standard of oral hygiene must be established prior to orthodontic treatment for at risk patients. Antibiotic prophylaxis in orthodontics should be used for procedures which cause gingival trauma eg band placement and removal. The daily use of a chlorhexidine mouthwash during treatment and prior to appliance adjustment is recommended.

Infective endocarditis associated with orthodontic treatment: a case report

A case of acute bacterial endocarditis associated with orthodontic treatment is described and the problems associated with orthodontic treatment for 'at risk' patients are discussed. The American Heart Association recommendations for orthodontic patients are summarized, and the general recommendations of the Endocarditis Working Party of the British Society for Antimicrobial Chemotherapy are appended.

Temporomandibular dysfunction syndrome associated with scuba diving mouthpieces

As previous reports have highlighted that temporomandibular joint dysfunction syndrome can occur during scuba diving due to the use of a diving mouthpiece, 74 divers of varied experience (62 male, 12 female) were asked to evaluate the efficiency of the mouthpiece for the ease of grip, insertion into the mouth, clearing of water, air sharing, comfort and overall efficiency. They also recorded the level of muscle and joint discomfort experienced during diving and non-diving activities. The results indicate that temporomandibular joint problems unrelated to diving are compounded by the use of a diving mouthpiece. The diver's assessment of muscle tension and comfort while using the mouthpiece was found to be a good predictor of whether temporomandibular dysfunction would occur and the assessment scores have been used in a formula to aid selection of a mouthpiece.

The effect of smoking on immediate post-extraction socket filling with blood and on the incidence of painful socket

The effect of habitual smoking on post-extraction socket filling with blood and on the incidence of painful socket, was investigated. Data were collected from 2417 adult dental out-patients in whom 3541 extractions were performed under local anaesthesia. Post-operative socket filling with blood was significantly reduced in smokers, compared with non-smokers (p less than 0.01). There was a higher incidence of painful socket in heavy smokers (20 or more cigarettes per day), compared with nonsmokers (p less than 0.05). There was a significant relationship between immediate post-extraction socket blood level and the incidence of painful socket; sockets which showed poorer filling were more likely to develop painful socket (p less than 0.02). Smoking appeared to have an adverse effect upon the healing of extraction wounds.

Local anaesthesia and dry socket. A clinical investigation of single extractions in male patients

1533 single intra-alveolar permanent tooth extractions in males were investigated in a study to determine if the type and technique of local anaesthesia influenced the occurrence of dry socket. The results show that the incidence of dry socket was significantly greater after the use of Xylocaine compared to Citanest and that the use of repeated injections or intraligamental techniques increased the likelihood of this painful post-extraction condition.