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Medicina (Kaunas, Lithuania) Dec 2019Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with...
Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.
Topics: Administration, Oral; Adult; Ambulatory Care; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Inhalation; Anti-Anxiety Agents; Benzodiazepines; Central Nervous System; Child; Conscious Sedation; Dental Anxiety; Dental Care; Dentistry; Humans; Nitrous Oxide; Operative Time; Postoperative Period; Safety
PubMed: 31817931
DOI: 10.3390/medicina55120778 -
American Journal of Public Health May 2017
Topics: Aged; Aged, 80 and over; Aging; Dental Care; Geriatric Dentistry; Health Services Accessibility; Humans; Oral Health; Periodontal Diseases
PubMed: 28661797
DOI: 10.2105/AJPH.2017.303835 -
Medicina (Kaunas, Lithuania) Oct 2019Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due...
Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.
Topics: Dental Anxiety; Dental Care; Fear; Humans; Psychology
PubMed: 31597328
DOI: 10.3390/medicina55100678 -
Ciencia & Saude Coletiva May 2018This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between... (Review)
Review
This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Dental Care; Dental Health Services; Dentists; Health Policy; Humans; Infant; Oral Health
PubMed: 29768610
DOI: 10.1590/1413-81232018235.20422016 -
Anesthesia Progress 2018Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With...
Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With the recent US Food and Drug Administration warning applied to many anesthetic/sedative agents for children less than 3 years old, a retrospective review of general anesthesia (GA) cases from 1 private pediatric dental practice was studied for age, gender, body mass index, anesthetic duration, airway management used, extent of dental surgical treatment, recovery time, and cardiac/pulmonary complications. For the 2016 calendar year, 351 consecutive GA cases were identified with patients aged 2-13 years. Of these, 336 underwent nasal endotracheal intubation. Forty-six of 351 patients (13%) were younger than 3 years. Median anesthesia duration was approximately 1.7 hours for all age groups. Dental treatment consisting of 8-9 teeth including crowns, fillings, and extractions was most frequently encountered. One hundred sixty-eight patients (48%), however, required care for 10-18 teeth. There were no episodes of significant oxygen desaturation. The overall complication rate was 1.1%, with 2 cases of postextubation croup, 1 case of mild intraoperative bronchospasm, and 1 case of intraoperative bradycardia. Complications did not correlate with children being overweight or obese.
Topics: Adolescent; Adolescent Behavior; Anesthesia Recovery Period; Anesthesia, General; Child; Child Behavior; Child, Preschool; Cooperative Behavior; Dental Care; Female; Humans; Infant; Intubation, Intratracheal; Laryngeal Masks; Male; Pediatric Dentistry; Respiration, Artificial; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 30715931
DOI: 10.2344/anpr-65-03-04 -
The Cochrane Database of Systematic... Dec 2015Crowns for primary molars are preformed and come in a variety of sizes and materials to be placed over decayed or developmentally defective teeth. They can be made... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Crowns for primary molars are preformed and come in a variety of sizes and materials to be placed over decayed or developmentally defective teeth. They can be made completely of stainless steel (know as 'preformed metal crowns' or PMCs), or to give better aesthetics, may be made of stainless steel with a white veneer cover or made wholly of a white ceramic material. In most cases, teeth are trimmed for the crowns to be fitted conventionally using a local anaesthetic. However, in the case of the Hall Technique, PMCs are pushed over the tooth with no local anaesthetic, carious tissue removal or tooth preparation. Crowns are recommended for restoring primary molar teeth that have had a pulp treatment, are very decayed or are badly broken down. However, few dental practitioners use them in clinical practice. This review updates the original review published in 2007.
OBJECTIVES
Primary objectiveTo evaluate the clinical effectiveness and safety of all types of preformed crowns for restoring primary teeth compared with conventional filling materials (such as amalgam, composite, glass ionomer, resin modified glass ionomer and compomers), other types of crowns or methods of crown placement, non-restorative caries treatment or no treatment. Secondary objectiveTo explore whether the extent of decay has an effect on the clinical outcome of primary teeth restored with all types of preformed crowns compared with those restored with conventional filling materials.
SEARCH METHODS
We searched the following electronic databases: Cochrane Oral Health Group Trials Register (to 21 January 2015), Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, 2014, Issue 12), MEDLINE via Ovid (1946 to 21 January 2015) and EMBASE via Ovid (1980 to 21 January 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials and Open Grey for grey literature (to 21 January 2015). No restrictions were placed on the language or date of publication when searching the databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) that assessed the effectiveness of crowns compared with fillings, other types of crowns, non-restorative approaches or no treatment in children with untreated tooth decay in one or more primary molar teeth. We would also have included trials comparing different methods of fitting crowns.For trials to be considered for this review, the success or failure of the interventions and other clinical outcomes had to be reported at least six months after intervention (with the exception of 'pain/discomfort during treatment and immediately postoperatively').
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the title and abstracts for each article from the search results. and independently assessed the full text for each potentially relevant study. At least two authors assessed risk of bias and extracted data using a piloted data extraction form.
MAIN RESULTS
We included five studies that evaluated three comparisons. Four studies compared crowns with fillings; two of them compared conventional PMCs with open sandwich restorations, and two compared PMCs fitted using the Hall Technique with fillings. One of these studies included a third arm, which allowed the comparison of PMCs (fitted using the Hall Technique) versus non-restorative caries treatment. In the two studies using crowns fitted using the conventional method, all teeth had undergone pulpotomy prior to the crown being placed. The final study compared two different types of crowns: PMCs versus aesthetic stainless steel crowns with white veneers. No RCT evidence was found that compared different methods of fitting preformed metal crowns (i.e. Hall Technique versus conventional technique).We considered outcomes reported at the dental appointment or within 24 hours of it, and in the short term (less than 12 months) or long term (12 months or more). Some of our outcomes of interest were not measured in the studies: time to restoration failure or retreatment, patient satisfaction and costs. Crowns versus fillingsAll studies in this comparison used PMCs. One study reported outcomes in the short term and found no reports of major failure or pain in either group. There was moderate quality evidence that the risk of major failure was lower in the crowns group in the long term (risk ratio (RR) 0.18, 95% confidence interval (CI) 0.06 to 0.56; 346 teeth in three studies, one conventional and two using Hall Technique). Similarly, there was moderate quality evidence that the risk of pain was lower in the long term for the crown group (RR 0.15, 95% CI 0.04 to 0.67; 312 teeth in two studies).Discomfort associated with the procedure was lower for crowns fitted using the Hall Technique than for fillings (RR 0.56, 95% CI 0.36 to 0.87; 381 teeth) (moderate quality evidence).It is uncertain whether there is a clinically important difference in the risk of gingival bleeding when using crowns rather than fillings, either in the short term (RR 1.69, 95% CI 0.61 to 4.66; 226 teeth) or long term (RR 1.74, 95% CI 0.99 to 3.06; 195 teeth, two studies using PMCs with conventional technique at 12 months) (low quality evidence). Crowns versus non-restorative caries treatmentOnly one study compared PMCs (fitted with the Hall Technique) with non-restorative caries treatment; the evidence quality was very low and we are therefore we are uncertain about the estimates. Metal crowns versus aesthetic crownsOne split-mouth study (11 participants) compared PMCs versus aesthetic crowns (stainless steel with white veneers). It provided very low quality evidence so no conclusions could be drawn.
AUTHORS' CONCLUSIONS
Crowns placed on primary molar teeth with carious lesions, or following pulp treatment, are likely to reduce the risk of major failure or pain in the long term compared to fillings. Crowns fitted using the Hall Technique may reduce discomfort at the time of treatment compared to fillings. The amount and quality of evidence for crowns compared to non-restorative caries, and for metal compared with aesthetic crowns, is very low. There are no RCTs comparing crowns fitted conventionally versus using the Hall Technique.
Topics: Child; Child, Preschool; Crowns; Dental Care for Children; Dental Caries; Dental Restoration Failure; Dental Restoration, Permanent; Female; Humans; Male; Molar; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 26718872
DOI: 10.1002/14651858.CD005512.pub3 -
Advances in Clinical and Experimental... Jul 2018Resulting in a high economic and biological cost, the traditional therapeutic approach to carious lesion management is still largely restorative. Minimally invasive (MI)... (Review)
Review
Resulting in a high economic and biological cost, the traditional therapeutic approach to carious lesion management is still largely restorative. Minimally invasive (MI) treatment offers an attractive alternative to managing carious lesions in a more conservative and effective manner, resulting in enhanced preservation of tooth structure. The aim of this review was to summarize the evidence behind several MI alternatives for carious lesion management, including the use of sealants, infiltration, atraumatic restorative treatment (ART), and selective carious tissue removal (e.g., indirect pulp capping, stepwise removal, or selective removal to soft dentine). Relevant literature was screened, and articles reporting randomized controlled trials or systematic reviews of strategies to manage non-cavitated or cavitated carious lesions in adults and children were included. Fifty six articles met the inclusion criteria. For non-cavitated lesions, the use of sealants is supported by strong evidence, while the evidence for infiltration of proximal lesions is moderate. For deep cavitated lesions, selective removal to soft dentin and/or stepwise excavation is supported by strong evidence. The use of the ART technique to restore cavitated lesions is also supported by strong evidence as a suitable strategy that has been used extensively in the literature concerning non-dental settings. Preservation of tooth structure through the use of MI treatment for both non-cavitated and cavitated lesions is supported by moderatestrong evidence, which supports the paradigm shift towards routine use of more conservative strategies in the treatment of carious lesions.
Topics: Dental Care; Dental Caries; Evidence-Based Dentistry; Humans
PubMed: 29962116
DOI: 10.17219/acem/77022 -
JNMA; Journal of the Nepal Medical... Jul 2020Quackery and fraud in dental practice, seen in many countries, is also rampant in Nepal, and they are unethical practices. There is a growing need for strict enforcement... (Review)
Review
Quackery and fraud in dental practice, seen in many countries, is also rampant in Nepal, and they are unethical practices. There is a growing need for strict enforcement of government policy measures to eliminate quackery and fraudulent dental practice in Nepal. The government should mobilize all dental workforce (dental specialists, dentists, and dental auxiliaries) and aware of their responsibilities and limitations. This article presents a brief review showing some cases of malpractice in dentistry in Nepal.
Topics: Credentialing; Dental Care; Ethics, Dental; Fraud; Government Regulation; Humans; Malpractice; Nepal; Practice Patterns, Dentists'; Quackery
PubMed: 32827024
DOI: 10.31729/jnma.5036 -
Caries Research 2019The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While...
The principles of minimally invasive dentistry clearly dictate the need for clinically effective measures to remineralize early enamel caries lesions. While fluoride-mediated remineralization is the cornerstone of current caries management philosophies, a number of new remineralization strategies have been commercialized or are under development that claim to promote deeper remineralization of lesions, reduce the potential risks associated with high-fluoride oral care products, and facilitate caries control over a lifetime. These non-fluoride remineralizing systems can be broadly categorized into biomimetic enamel regenerative technologies and the approaches that repair caries lesions by enhancing fluoride efficacy. This paper discusses the rationale for non-fluoride remineralization and the mechanism of action, challenges, and evidence behind some of the most promising advances in enamel remineralization therapies.
Topics: Dental Care; Dental Caries; Dental Enamel; Fluorides; Humans; Tooth Remineralization
PubMed: 30296788
DOI: 10.1159/000493031 -
Disease-a-month : DM Sep 2020As a pathogen spread primarily by the respiratory route COVID-19 infection not only poses significant risks to health care workers, but to dentists and dental health... (Review)
Review
As a pathogen spread primarily by the respiratory route COVID-19 infection not only poses significant risks to health care workers, but to dentists and dental health care workers, owing to the potential prolonged exposure and proximity to patients. This holds true for non-dentist health care workers who often in the setting of emergency departments and urgent care centers are tasked with addressing oral symptoms including abscesses, damaged teeth, jaw injuries and other dental urgencies. Infection control practice guidelines were evaluated for COVID-19 infection prevention in a dental setting. In this brief review, protective measures to reduce the risk of COVID-19 infection for dentists and non-dentist health care providers will be introduced. This includes patient evaluation, personal and patient protective equipment use, sterilization and disinfection protocols.
Topics: COVID-19; COVID-19 Testing; Dental Care; Dentists; Health Personnel; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Personal Protective Equipment; SARS-CoV-2
PubMed: 32741545
DOI: 10.1016/j.disamonth.2020.101056