[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Hebrew edition].

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented. The Hebrew Edition is part of the IADT global effort to provide accessibility to these guidelines worldwide.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Hebrew edition].

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This scond part of the guidelines will focus on avulsion of permanent teeth.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Hebrew edition].

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition.

Depth and distance perception of dentists and dental students.

The quality of work carried out by dentists is dependent, among other things, on experience, training, and manual dexterity. Historical focus on the latter as a predictor of dental performance has failed to recognize that dental competence also requires good perceptual and visual skills, not only for gathering information but also for judging positions, distances, and the size of objects and shapes. Most predictive tests ignore visual and interpretative deficiencies that could make individual acquisition of skills and interpretation of instructions difficult. Ability to estimate depth and distance, the manner in which students learn this ability, whether and how it can be taught, or whether there is an association among ability, stereopsis, and dental performance has not been thoroughly examined; nor has the perception that dental students fully understand verbal and written instruction relating to depth and distance. This study investigated the ability of dentists and dental students to estimate and reproduce small depths and distances and the relationship of this ability to stereopsis, dental experience, and student performance. A total of 163 undergraduate dental students from three year groups and 20 experienced dentists and specialists performed three tasks. A depth-perception task involved estimation of the depth of two sets (2-mm or 4-mm wide) of nine computer milled slots ranging in depth from 0.5 to 4.0 mm. A distance task involved estimation of the width of specially prepared printed square blocks. In a writing task, participants recorded distances across a printed line on separate sheets of paper. All tasks were conducted at set positions in custom-made transportable light boxes. Stereopsis and visual acuity were also measured. Ability to perform perceptual tasks varied enormously, with the level of accuracy dependent on the type of task and dental experience. Many students had considerable difficulty in estimating depth. Inexperienced students performed poorly. Most participants overestimated depth and distance estimation tasks, but underestimated when required to draw distances. Smaller depths and distances were easier to estimate than larger ones. All groups overestimated depth more in 4-mm-wide blocks than in 2-mm-wide blocks. There was no correlation found between depth and distance estimation and stereopsis scores or with the overall grades tested. This study highlights that some dentists and many dental students, particularly early in their course, have great difficulty in accurately gauging depths and distances. It is proposed that that this could impact significantly on a student's ability to interpret verbal and written preclinical instruction and could make the acquisition of manual skills and interpretation of clinical instruction difficult. Routine testing of all undergraduate dental students for perceptual and visual difficulties is recommended, so that those with difficulties can be identified and problems remedied, if possible, early in their course.

Approach to high-resolution ex situ NMR spectroscopy.

Nuclear magnetic resonance (NMR) experiments are typically performed with samples immersed in a magnet shimmed to high homogeneity. However, there are many circumstances in which it is impractical or undesirable to insert objects or subjects into the bore of a high-field magnet. Here we present a methodology based on an adaptation of nutation echoes that provides resolved spectra in the presence of matched inhomogeneous static and radiofrequency fields, thereby opening the way to high-resolution ex situ NMR. The observation of chemical shifts is regained through the use of multiple-pulse sequences of correlated, composite z-rotation pulses, producing resolved NMR spectra of liquid samples.

Oral health practices and knowledge among parents and hired caregivers.

AIM: To investigate the oral healthcare practices and knowledge of parents and nannies in Kuwait. METHODS: A cross-sectional interview-based survey was carried out on parents and nannies to explore their demographics, oral health care practices and knowledge. Independent t-test was used to assess differences in practice and knowledge between parents and nannies. Multiple linear regression compared practice and knowledge of parents and nannies, adjusting for age, time spent in childcare, national origin, education, governorate of residence and number of other children in the household. RESULTS: Three-hundred caregivers were interviewed, parents (N = 146, 49%) and nannies (N = 154, 51%). Parents had a higher mean practice score (parents 3.25, nannies 2.69, p < 0.001), but a similar knowledge score to nannies (parents 38.0, nannies 37.6, p > 0.48). Governorate of residence predicted lower practice scores for parents residing north of the Kuwaiti capital compared to those residing elsewhere (ß = - 0.571, p < 0.05). Education weakly predicted lower practice scores for nannies beyond high school, but better scores for parents with a college degree. Education also predicted higher knowledge scores among nannies with college degrees (ß = 2.249, p = 0.06), but for the lower knowledge scores (ß = - 3.693, p = 0.08) among parents with college degrees. CONCLUSION: Caregivers' oral health practices and knowledge scores were good. However, nannies had poorer child oral healthcare practices. Results highlight the need to involve nannies in child oral healthcare education.

The endodontic management of traumatized permanent anterior teeth: a review.

Despite the many journal articles and reviews that have been published regarding the treatment of trauma to teeth, the endodontic management of these injuries is often still not fully understood. The purpose of this review is to establish clear and up-to-date guidelines for practitioners who are faced with treating dental injuries on a day-to-day basis, based on an assessment of current available scientific information relating to the endodontic management of these injuries. Treatment is discussed under the headings: infractions, uncomplicated crown fractures, complicated crown fractures, crown-root fractures, root fractures, luxation injuries, avulsion, root resorption, pulp canal obliteration and open-apex teeth. Emphasis is placed on the treatment of traumatized immature teeth where maintenance of pulp blood supply is important to encourage continued development of the root system. Only the treatment of traumatized permanent anterior teeth is reviewed. Information contained in this article is based on a review of the literature on dental trauma which involved a MEDLINE search using the key words "dental trauma" and the individual topics listed above. The guidelines produced by the International Association of Dental Traumatology, the American Academy of Pediatric Dentistry and the American Association of Endodontists were also reviewed and the recommendations contained in this paper are in concert with the major recommendations of these bodies.

Dissolution of porcine incisor pulps in sodium hypochlorite solutions of varying compositions and concentrations.

BACKGROUND: The solubility of dental pulp tissue in sodium hypochlorite has been extensively investigated but results have been inconsistent; due most likely to variations in experimental design, the volume and/or rate of replenishment of the solutions used and the nature of the tissues assessed. Traditionally, the sodium hypochlorite solutions used for endodontic irrigation in Australia have been either Milton or commercial bleach, with Milton being the most common. Recently, a range of Therapeutic Goods Administration (TGA) approved proprietary sodium hypochlorite solutions, which contain surfactant, has become available. Some domestic chlorine bleaches now also contain surfactants. The purpose of this study was to perform new solubility assessments, comparing Milton with new TGA approved products, Hypochlor 1% and Hypochlor 4% forte, and with a domestic bleach containing surfactant (White King). METHODS: Ten randomly assigned pulp samples of porcine dental pulp of approximately equal dimensions were immersed in the above solutions, as well as representative concentrations of sodium hydroxide. Time to complete dissolution was measured and assessed statistically. RESULTS: White King 4% showed the shortest dissolution time, closely followed by Hypochlor 4% forte. White King 1% and Hypochlor 1% each took around three times as long to completely dissolve the samples of pulp as their respective 4% concentrations, while Milton took nearly 10 times as long. The sodium hydroxide solutions showed no noticeable dissolution of the pulp samples. CONCLUSIONS: The composition and content of sodium hypochlorite solutions had a profound effect on the ability of these solutions to dissolve pulp tissue in vitro. Greater concentrations provided more rapid dissolution of tissue. One per cent solutions with added surfactant and which contained higher concentrations of sodium hydroxide were significantly more effective in dissolution of pulp tissue than Milton.

Emergency assessment and treatment planning for traumatic dental injuries.

Trauma involving the dentoalveolar region is a frequent occurrence which can result in the fracturing and displacement of teeth, crushing and/or fracturing of bone and soft tissue injuries including contusions, abrasions and lacerations. This review describes the assessment of patients with these injuries, not in a didactic sense by repeating excellent already published classifications and treatment options, but by addressing questions that arise during assessment. It covers trauma first aid, examination of the patient, factors that affect treatment planning decisions, and the importance of communicating treatment options and prognosis to traumatized patients.

Structure of the O-specific polysaccharide from Enterobacter cloacae strain N.C.T.C. 11579 (serogroup O10).

The O-specific polysaccharide from the reference strain (N.C.T.C. 11579) for Enterobacter cloacae serogroup O10 has been isolated and characterised. By means of n.m.r. spectroscopy and methylation analysis, and by studies of the products obtained by Smith degradation or by N-deacetylation-deamination, the repeating unit of the polysaccharide could be allocated the structure shown. The polysaccharides from two cross-reacting serogroups (O9 and O11) have the same monosaccharide composition. (Formula: see text)

Diagnosis and management of teeth with vertical root fractures.

Vertical fractures in teeth can present difficulties in diagnosis. There are, however, many specific clinical and radiographical signs which, when present, can alert clinicians to the existence of a fracture. In this review, the diagnosis of vertical root fractures is discussed in detail, and examples are presented of clinical and radiographic signs associated with these fractured teeth. Treatment alternatives are discussed for both posterior and anterior teeth.

Sodium hypochlorite and its use as an endodontic irrigant.

Sodium hypochlorite has been used as an endodontic irrigant for more than 70 years, and is now one of the most common solutions for this purpose. The chemical properties and production of commercial sodium hypochlorite are reviewed. Domestic bleaches and an infant sanitizer are compared from the point of view of cost and ease of use--Milton being recommended where a 1% solution is required. The cost of syringes and needles for endodontic irrigation is many times greater than the hypochlorite they contain, and total annual practice costs for hypochlorite are low. Brief guidelines for clinical use, storage, handling and disposal are included.

Donor variability in the proliferation of human dental pulp fibroblasts.

Fibroblasts were isolated from human dental pulps of healthy third molars from 49 donors of ages ranging from 17 to 68. Significant variability was noted in the success of obtaining primary cultures from these pulps. Variability between the various cultures was also observed in the reliability of maintaining subcultures of the primary cultures as well as recovery from frozen stocks of established cell lines. Of the original 49 explant cultures studied, only three survived long-term passage and freezing. In addition to difficulties and variability in establishing cell lines, the human pulp fibroblasts also showed great variability in proliferative activity which could not be accounted for by donor age, source, or passage number. These findings highlight significant difficulties in establishing reliable human pulp fibroblast cultures and the need for great care in interpreting any in vitro data.

The shelf-life of sodium hypochlorite irrigating solutions.

BACKGROUND: Sodium hypochlorite (bleach) solutions are widely used as irrigants in endodontics. Their tendency to deteriorate is worsened by environmental influences which could cause loss of available chlorine content. METHODS: This study measured the loss of available chlorine concentration in a range of sodium hypochlorite solutions under conditions which mimic clinical usage and storage. Domestic bleach, both undiluted and diluted with demineralised water or hard water, was tested, along with Milton, for initial concentration of available chlorine, and then retested after varying periods and modes of storage to measure loss of chlorine concentration. The types of storage were: (1) in closed plastic bottles which were opened daily and agitated; (2) in open plastic bottles; (3) in syringes exposed to sunlight; (4) in syringes kept in the dark; (5) in open stainless steel bowls; (6) in closed stainless steel bowls; and (7) when heated to 50 degrees C. Not all solutions were tested under all storage conditions. RESULTS: Of the solutions opened daily, undiluted domestic bleach was the most stable and Milton was the least stable. Initially, diluted bleach left open deteriorated rapidly but deterioration slowed with time. Solutions in syringes exposed to sunlight showed the most rapid loss of chlorine content. Heated bleach lost nearly 5 per cent of its strength in six hours. Diluted bleach surprisingly, increased its chlorine concentration in open bowls probably due to evaporation of water. Dilution of bleach with hard tap water did not significantly affect shelf-life. Preloading of diluted bleach into syringes appears to be a sound technique if the syringes are stored away from light. CONCLUSIONS: This study reinforces the need for sodium hypochlorite to be stored in closed opaque containers. Constant opening of containers appears to cause greater loss in chlorine concentration of diluted bleach solutions, perhaps because a lower concentration of sodium hydroxide allows the pH to drop more rapidly.

A comparison of Kodak Ultraspeed and Ektaspeed plus dental X-ray films for the detection of dental caries.

BACKGROUND: Using the fastest dental X-ray film available is an easy way of reducing exposure to ionizing radiation. However, the diagnostic ability of fast films for the detection of proximal surface caries must be demonstrated before these films will become universally accepted. METHODS: Extracted premolar and molar teeth were arranged to simulate a bitewing examination and radiographed using Ultraspeed and Ektaspeed Plus dental X-ray films. Three different exposure times were used for each film type. Six general dentists were used to determine the presence and depth of the decay in the proximal surfaces of the teeth radiographed. The actual extent of the decay in the teeth was determined by sectioning the teeth and examining them under a microscope. RESULTS: There was no significant difference between the two films for the mean correct diagnosis. However, there was a significant difference between the means for the three exposure times used for Ultraspeed film. The practitioners used were not consistent in their ability to make a correct diagnosis, or for the film for which they got the highest correct diagnosis. CONCLUSIONS: Ektaspeed Plus dental X-ray film is just as reliable as Ultraspeed dental X-ray film for the detection of proximal surface decay. The effect of underexposure was significant for Ultraspeed, but not for Ektaspeed Plus. Patient exposure can be reduced significantly with no loss of diagnostic ability by changing from Ultraspeed X-ray film to Ektaspeed Plus X-ray film.

A comparison of Kodak Ultraspeed and Ektaspeed Plus dental X-ray films for use in endodontics.

BACKGROUND: The advantage of using a faster film for length determination in endodontic therapy is obvious. However, for such a film to be generally accepted, it must demonstrate comparable diagnostic quality to traditionally used films. METHODS: The comparative accuracy of canal length determination of Ultraspeed and Ektaspeed Plus dental X-ray films was assessed in maxillary first and second molars; for different canals, for different teeth, for different exposures, and for different examiners (five general dentists and three endodontic specialists). RESULTS: In general, there were no significant differences between films, among examiners, or any interaction between films and exposures. That is, an assessor's ability to estimate lengths was not significantly influenced by the film type or by exposure used. There was a wide divergence in the individual assessor's ability to estimate lengths. Specialists estimated lengths more accurately than general practitioners and estimated lengths more accurately with Ektaspeed Plus film. Length determination in distobuccal and mesiobuccal canals was more accurate than in palatal canals. Most palatal canals were underestimated in length by more than 1mm. The use of file sizes larger in number than size 15 is recommended in these canals. CONCLUSION: For length determination, Ektaspeed Plus dental X-ray film is as effective as Ultraspeed film. Given the acceptable quality and accuracy of Ektaspeed Plus film, there seems to be no clinical reason to subject patients to greater radiation by using a slower film during endodontic therapy.

A survey of sodium hypochlorite use by general dental practitioners and endodontists in Australia.

BACKGROUND: Sodium hypochlorite is used commonly as an endodontic irrigant, but there are no published reports that provide details of its use. This survey sought to determine the percentage of Australian dentists who practiced endodontics, whether they used sodium hypochlorite for irrigation, and the manner of dilution, storage and dispensing sodium hypochlorite used by both dentists and endodontists. METHODS: All Australian endodontists and a stratified random sample of 200 general dentists in Australia were surveyed to address the issues identified above. RESULTS: Almost 98 per cent of dentists surveyed performed endodontic treatment. Among endodontists, nearly 94 per cent used sodium hypochlorite for irrigation compared with just under 75 per cent of general dentists. Sodium hypochlorite use by general dentists was more common in Victoria and South Australia than in other States. An infant sanitizer (Milton or Johnson's Antibacterial Solution) was used by just over 92 per cent of general practitioners and by more than 67 per cent of endodontists. All other respondents used domestic bleach. One hundred and sixty four of the respondents (80 per cent of endodontists and over 90 per cent of general dentists) used a 1 per cent w/v solution. Ten practitioners used a 4 per cent w/v solution, five used a 2 per cent w/v solution and four used a 1.5 per cent w/v solution. Eighty per cent of the practitioners who diluted their sodium hypochlorite before use, used demineralized water for this purpose. The remainder used tap water. Only four practitioners stored sodium hypochlorite in a manner which risked light exposure and loss of available chlorine content. CONCLUSIONS: Sodium hypochlorite is commonly used as an endodontic irrigant and Australian dentists generally stored the material correctly.

Changes in root canal morphology in simulated curved canals over-instrumented with a variety of stainless steel and nickel titanium files.

The purpose of this project was to observe the amount of apical and mid-curve transportation produced by a range of nickel titanium (NiTi), titanium alloy and stainless steel (SS) files. Tests were carried out in simulated curved root canals produced in epoxy resin blocks. Seven commercially available file types were tested using sizes 15 to 40. Instrumentation was carried out to 1 mm beyond the apex. Changes in canal dimensions were measured at 10x magnification under a shadowgraph. There were substantial differences in the amount and the pattern of apical and mid-curve transportation produced. The amount of transportation increased with each subsequent size of file. Under the same conditions, nickel titanium files produced significantly less transportation than stainless steel files. The least apical transportation was obtained with the NiTi Mity Turbo and the most by the SS K file and SS Hedstrom file. The least mid-curve transportation was produced by the NiTi Mity Turbo and the most by the SS Hedstrom file.

Bacterial contamination of cracks in symptomatic vital teeth.

As part of an ongoing study on the initiation of cracks in teeth, 20 teeth exhibiting symptoms consistent with the presence of dentinal cracks were examined. The presence of a cracked cusp was confirmed by the selective application of pressure either with a mirror handle or Fracfinder (Svenoka, Dental Instruments, Vasby, Sweden). Cracked cusps were fractured from the teeth after the removal of all existing restorations and were immediately placed into ten percent formalin. Subsequently, specimens were dehydrated, sputter-coated and examined under the scanning electron microscope (SEM). All the cracked cusps exhibited complete fracture of the dentine to the level of the dentino-enamel junction. No partial fractures were seen. Numerous bacteria of many morphological forms were present on the dentinal surfaces, of all fractured cusps, in all teeth. Cocci, bacilli and filamentous forms were consistently found. Many bacteria were in the process of division. While bacterial contamination of dentinal cracks has been described in histological studies, the nature and distribution of these bacterial and fungal forms has not been shown previously in any detail. Prior SEM studies investigating the nature and mechanisms of fracture have not revealed bacterial contamination of the fractured surface. This paper draws attention to the fact that all symptomatic cracks in teeth appear to 1. extend right through the dentine to the dentino-enamel junction, and 2. appear to be extensively contaminated by bacteria.

Assessment of residual active chlorine in sodium hypochlorite solutions after dissolution of porcine incisor pulpal tissue.

BACKGROUND: In previous studies, surfactant-containing Hypochlor brands of sodium hypochlorite showed better tissue solubilizing abilities than Milton; differences not explained by original active chlorine content or presence of surfactant. It was postulated that exhaustion of active chlorine content could explain differences. This study aimed to assess whether Milton's poorer performance was due to exhaustion of active chlorine. Parallel experiments assessed the influence of titration methods, and the presence of chlorates, on active chlorine measurements. METHODS: Time required to dissolve one or groups of 10 samples of porcine incisor pulp samples in Milton was determined. Residual active chlorine was assessed by thermometric titration. Iodometric and thermometric titration was carried out on samples of Milton. Chlorate content was also measured. RESULTS: Dissolution of single and 10 pulp samples caused a mean loss of 1% and 3% respectively of active chlorine, not being proportional to tissue dissolved. Thermometric ammonium ion titration resulted in 10% lower values than iodometric titration. Chlorate accounted for much of this difference. CONCLUSIONS: Depletion of active chlorine is not the reason for differences in tissue dissolving capabilities of Milton. Thermometric ammonium ion titration gives more accurate measurement of active chlorine content than iodometric titration.