Specialty dentistry for the hemophiliac: is there a protocol in place? (17/81)

Restorative dental care for the hemophiliac patient is of paramount importance for the fact that advanced dental conditions and subsequent treatments prove to be more complicated and risky. Quite often, dental health is neglected by hemophiliacs for fear of bleeding during procedures. Surprisingly, even dental specialists avoid these candidates and contribute to the conversion ofa simple dental patient to an oral surgical patient. The complexities involved in diagnosing a bleeding disorder and the rarity of a standardized protocol to handle such patients contribute to this problem. This article prescribes a simple protocol to diagnose bleeding disorders and a modified scheme for endodontic and periodontal therapy in a hemophiliac patient.  (+info)

Restoration of a vertical tooth fracture and a badly mutilated tooth using canal projection. (18/81)

Management of vertically fractured tooth or a perforation frequently poses problem during endodontic management. Such teeth often need a pre-endodontic restoration prior to initiation of root canal therapy to aid in the placement of rubber dam clamp. This paper describes a simple method of placement of a pre-endodontic restoration using the canal projection technique using hollow metallic needles as sleeves.  (+info)

The impact of targeted shortened preclinical exercises on student perceptions and outcomes. (19/81)

The Harvard School of Dental Medicine (HSDM) introduced problem-based learning (PBL) into the dental curriculum in 1994 as a part of curriculum reform. During the reorganization, departments were consolidated, and courses were taught in an interdisciplinary fashion rather than in a discipline-based approach. The changes required a reduction in lecture and preclinical clock hours, which might have affected student performance and anxiety levels. The objectives of this study were to 1) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics before and after PBL implementation; 2) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics with other schools nationwide; 3) measure students' perceptions of their levels of stress and self-confidence at two time points during their preclinical and clinical years; 4) investigate the correlation between the number of preclinical hours and the students' stress level and self-confidence; and 5) evaluate the impact of shortened preclinical hours on the performance of HSDM students on the National Board Dental Examination Parts I and II. A survey regarding the students' level of stress, self-confidence, and preparation to treat patients during preclinical laboratory exercises was distributed to the HSDM classes of 2005 and 2006 (n=70). The HSDM preclinical curriculum hours were compared to national data as reported by the American Dental Association (ADA). Cross-tabulations were constructed, and the Fisher's exact test was conducted to examine the relationships between the variables. We found that HSDM preclinical hours in Endodontics, Operative, and Prosthodontics were significantly lower than at other schools. During the preclinical exercises, the Prosthodontics preclinical exercises were found to be the most stressful and provided the lowest self-confidence in treating patients as compared to the other preclinical subject areas. HSDM students' scores on the National Board Part I and II examinations continue to be among the highest in the nation and have not been affected by the change in curriculum. We conclude that the change in HSDM's curriculum that resulted in targeted, shorter preclinical exercises has not affected clinical and didactic outcomes, but may have affected the anxiety that students feel when entering the clinic.  (+info)

Teaching alternatives to the standard inferior alveolar nerve block in dental education: outcomes in clinical practice. (20/81)

Surveys were sent to Harvard School of Dental Medicine students and graduates from the classes of 2000 through 2006 to determine their current primary means of achieving mandibular anesthesia. Orthodontists and orthodontic residents were excluded. All subjects received clinical training in the conventional inferior alveolar nerve block and two alternative techniques (the Akinosi mandibular block and the Gow-Gates mandibular block) during their predoctoral dental education. This study tests the hypothesis that students and graduates who received training in the conventional inferior alveolar nerve block, the Akinosi mandibular block, and the Gow-Gates mandibular block will report more frequent current utilization of alternatives to the conventional inferior alveolar nerve block than clinicians trained in the conventional technique only. At the 95 percent confidence level, we estimated that between 3.7 percent and 16.1 percent (mean=8.5 percent) of clinicians trained in using the Gow-Gates technique use this injection technique primarily, and between 35.4 percent and 56.3 percent (mean=47.5 percent) of those trained in the Gow-Gates method never use this technique. At the same confidence level, between 0.0 percent and 3.8 percent (mean=0.0 percent) of clinicians trained in using the Akinosi technique use this injection clinical technique primarily, and between 62.2 percent and 81.1 percent (mean=72.3 percent) of those trained in the Akinosi method never use this technique. No control group that was completely untrained in the Gow-Gates or Akinosi techniques was available for comparison. However, we presume that zero percent of clinicians who have not been trained in a given technique will use the technique in clinical practice. The confidence interval for the Gow-Gates method excludes this value, while the confidence interval for the Akinosi technique includes zero percent. We conclude that, in the study population, formal clinical training in the Gow-Gates and Akinosi injection techniques lead to a small but significant increase in current primary utilization of the Gow-Gates technique. No significant increase in current primary utilization of the Akinosi technique was found.  (+info)

Use of an Electronic Patient Record system to evaluate restorative treatment following root canal therapy. (21/81)

Electronic Patient Record (EPR) systems are rapidly gaining acceptance as an important tool for managing patient information. The purpose of this project was to evaluate the use of an EPR system for assessment of quality of care in an academic dental institution. The primary outcome of interest was the timeliness and completeness of restorative care following completion of nonsurgical root canal therapy. An initial query of the EPR database was performed using the following inclusion criteria: root canal treatment performed in the postgraduate endodontics clinic between September 2002 and June 2004, patient age > or =18 years old, and posterior tooth (premolars and molars). A total of 925 patients with 1,014 endodontically treated teeth met the inclusion criteria. A random sample of 30 percent of the treated teeth (302 teeth on 281 patients) was selected for detailed review. This sample of 302 teeth was then screened to determine if any restorative treatment had been performed between September 2002 and November 2005. Forty-eight percent (n=146) of the 302 teeth did not receive any form of permanent restoration over the time period studied. Twenty-five percent (n=75) of the teeth received a buildup only, and 27 percent (n=82) received the recommended treatment, a full occlusal coverage restoration. This study documents the use of an EPR system to objectively and efficiently assess one aspect of quality of care in a dental school environment.  (+info)

Risk assessment of transmission of sporadic Creutzfeldt-Jakob disease in endodontic practice in absence of adequate prion inactivation. (22/81)

BACKGROUND: Experimental results evidenced the infectious potential of the dental pulp of animals infected with transmissible spongiform encephalopathies (TSE). This route of iatrogenic transmission of sporadic Creutzfeldt-Jakob disease (sCJD) may exist in humans via reused endodontic instruments if inadequate prion decontamination procedures are used. METHODOLOGY/PRINCIPAL FINDINGS: To assess this risk, 10 critical parameters in the transmission process were identified, starting with contamination of an endodontic file during treatment of an infectious sCJD patient and ending with possible infection of a subsequent susceptible patient. It was assumed that a dose-risk response existed, with no-risk below threshold values. Plausible ranges of those parameters were obtained through literature search and expert opinions, and a sensitivity analysis was conducted. Without effective prion-deactivation procedures, the risk of being infected during endodontic treatment ranged between 3.4 and 13 per million procedures. The probability that more than one case was infected secondary to endodontic treatment of an infected sCJD patient ranged from 47% to 77% depending on the assumed quantity of infective material necessary for disease transmission. If current official recommendations on endodontic instrument decontamination were strictly followed, the risk of secondary infection would become quasi-null. CONCLUSION: The risk of sCJD transmission through endodontic procedure compares with other health care risks of current concern such as death after liver biopsy or during general anaesthesia. These results show that single instrument use or adequate prion-decontamination procedures like those recently implemented in dental practice must be rigorously enforced.  (+info)

A virtual system for cavity preparation in endodontics. (23/81)

This article presents a novel virtual teeth drilling system designed to aid dentists, dental students, and researchers in getting acquainted with teeth anatomy, the handling of drilling instruments, and the challenges associated with drilling procedures during endodontic therapy. The system is designed to be used for educational and research purposes in dental schools. The application features a 3D face and oral cavity model constructed using anatomical data that can be adapted to the characteristics of a specific patient using either facial photographs or 3D data. Animation of the models is also feasible. Virtual drilling using a Phantom Desktop (Sensable Technologies Inc., Woburn, MA) force feedback haptic device is performed within the oral cavity on 3D volumetric and surface models of teeth, obtained from serial cross sections of natural teeth. Final results and intermediate steps of the drilling procedure can be saved on a file for future use. The application has the potential to be a very promising educational and research tool that allows the user to practice virtual teeth drilling for endodontic cavity preparation or other related procedures on high-detail teeth models placed within an adaptable and animated 3D face and oral cavity model.  (+info)

A nonsurgical endodontics relational research database: the initial six years of experience. (24/81)

The purpose of this study was to report results of the initial six years of experience utilizing a nonsurgical root canal treatment (NSRCT) database; to compare patient characteristics, operative procedures, and patient outcomes observed in the database to those observed in other studies; and to discuss the potential benefits of a clinical endodontic database. A total of 7,372 NSRCT cases performed by endodontic residents at the University of Pennsylvania from 2000 to 2006 were evaluated. The odds ratio (OR) for caries and trauma being causative agents for NSRCT in +info)