The importance of the initial comprehensive dental examination.

New diagnostic technology that improves patient care is becoming more common in dental practices at both the generalist and specialist levels. However, new diagnostic tests may be ordered prematurely or given more importance than warranted, resulting in misdiagnoses or delay of appropriate treatment. In this report, we describe a case in which several oral health care professionals failed to diagnose persistent facial pain correctly, in part because of failure to conduct a comprehensive dental examination and over-reliance on new technology. During 13 months of persistent mandibular pain, various diagnoses and treatments, the patient did not have a comprehensive dental examination-an examination that would have revealed periradicular periodontitis in tooth 25 causing the referred mandibular pain. This case demonstrates the importance and value of the initial comprehensive history and clinical examination, followed by conventional imaging to arrive at an accurate diagnosis and treatment plan.

The Multisensory/Snoezelen Environment to Optimize the Dental Care Patient Experience.

This article provides a brief overview of how the environment can affect behavior and that well-designed spaces can affect how patients handle stress. The application of the Snoezelen multisensory interactive calming strategies and devices that were installed in all facets of a community dental practice are described. These principles of creating a calming dental home improved behavior, cooperation, and satisfaction with care in persons with disabilities and reduced the need for sedation or general anesthesia. It is proposed that the creation of similar clinics with multisensory calming features could improve community access to dental care for persons with special needs.

Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study.

BACKGROUND: Limited information exists regarding the use of stainless steel crowns (SSCs) in permanent teeth. The objective of this retrospective cohort study was to present the long-term clinical outcomes of the SSC compared with those of amalgam and composite resin restorations and the SSC radiographic outcomes in a special-needs population. METHODS: This study included 271 patients with at least 1 SSC restoration from the Mount Sinai Hospital Dentistry Clinic for Persons with Special Needs in Toronto, Ontario, Canada. A total of 2,621 posterior permanent tooth restorations were documented: 766 SSCs, 1,651 amalgam restorations, and 204 composite resin restorations. Clinical analysis included patient demographics, treatment parameters, and outcome assessments for each restoration recorded. Radiographic analysis of SSC restorations included 127 bite-wing radiographs and 118 periapical radiographs, measurement of interproximal bone loss, and assessment of periapical status using the Periapical Index Scale. RESULTS: The 10-year survival rates for new SSC and amalgam restorations were 79.2% and 63.5%, respectively. The 91 SSC failures included 2 recementations, 33 replacements, and 56 extractions. Primary diagnoses at the time of failure included chronic periodontal disease (25) and loose or lost SSCs (24). Of the 528 failed conventional restorations that were replaced, 60% were replaced with SSCs. The mean alveolar bone loss from mesial and distal sites was 1.36 millimeters and 1.40 mm, respectively. Therefore, 93% of the sites recorded were less than 2 mm and classified as healthy. All pre-SCC and post-SSC periapical radiographs had healthy Periapical Index Scale scores (1 or 2) recorded over an average duration of 8.4 years (1-29.1 years). CONCLUSIONS: SSCs are a durable treatment option for the restoration of the posterior permanent dentition. PRACTICAL IMPLICATIONS: Posterior permanent teeth restored with stainless steel crowns can be expected to last for 10 years and represent a viable treatment choice for severely carious or fractured posterior permanent teeth.