Computerized dental injection fear treatment: a randomized clinical trial.

One in four adults reports a clinically significant fear of dental injections, leading many to avoid dental care. While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists' lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment. Computer Assisted Relaxation Learning (CARL) is a self-paced computerized treatment based on systematic desensitization for dental injection fear. This multicenter, block-randomized, dentist-blind, parallel-group study conducted in 8 sites in the United States compared CARL with an informational pamphlet in reducing fear of dental injections. Participants completing CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control individuals (p < .001). Twice as many CARL participants (35.3%) as controls (17.6%) opted to receive a dental injection after the intervention, although this was not statistically significant. CARL, therefore, led to significant changes in self-reported fear in study participants, but no significant differences in the proportion of participants having a dental injection.

An anatomically realistic and adaptable prostate phantom for laser thermotherapy treatment planning.

PURPOSE: To construct a phantom for prostate cancer laser based thermotherapy treatment planning and simulation. METHODS: A realistic and adaptable prostate phantom was designed. It exhibits the following properties: valid and complete description of the prostate anatomy, material with similar optical properties of prostate tissues and compatibility with clinical imaging protocols mainly multiparametric magnetic resonance (MR) and transrectal ultrasound imaging (TRUS). RESULTS: Preliminary experiments with the phantom using an interstitial laser treatment protocol allowed obtaining results similar to those obtained on preclinical model. CONCLUSIONS: These results proved that this phantom could allow a real simulation of laser therapy procedure: target definition and fibers' placement optimization using MR imaging, treatment delivery, and finally treatment monitoring using TRUS imaging.

Pain control in recovering alcoholics: effects of local anesthesia.

OBJECTIVE: The medical literature suggests that alcoholics may present greater challenges to achieving clinical pain control than nonalcoholics. This study was undertaken to test the hypotheses that: (1) significant differences exist between alcoholics and nonalcoholics on detection and pain thresholds during electric tooth stimulation; (2) group differences exist in the depth and time course of pulpal anesthesia; and (3) responses to tooth stimulation are associated with severity of alcoholism and/or other psychological factors. METHOD: Male alcoholics (n = 22) in aftercare treatment (mean length of sobriety = 113 days) and age-matched nonalcoholics (n = 22) received 1.0 ml of 3% mepivicaine at the apex of a maxillary lateral incisor and saline placebo at the apex of the contralateral incisor. RESULTS: At baseline no group differences were found on sensory thresholds. During drug intervention significant drug and time effects for both detection threshold (p < .0001) and pain threshold (p < .0001) were found, but group differences and interactive effects were not significant. By exploratory regression analysis of alcoholic subjects, history of depression/unhappiness was significantly associated with shallower pulpal anesthesia, whereas high need for control/low actual control and frequency of treatment for detoxification were associated with deeper anesthesia. CONCLUSIONS: Our findings suggest alcoholics in recovery are not at increased risk for inadequate pain control with local anesthesia.

Chlorhexidine swabbing applications under various conditions of use in preventive oral care for persons with disabilities.

A sample of 44 adults with severe disabilities completed a randomized single-blind cross-over study testing chlorhexidine swabbing under various conditions: with/without prior dental prophylaxis, reduced frequency of application (2 vs. 5 times per week), and prolonged use (42 weeks). All subjects received therapeutic doses of 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) and 10 mL 0.05% NaF applied with a Toothette (Sage Products). Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported. In the present study, while initial benefits were observed to be independent of dental prophylaxis, significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol, at reduced frequency of application and over prolonged time. High levels of acceptance and compliance by subjects/caregivers were maintained. Subjects/caregivers reported improvements in dental health as well as in attitude, quality of life, and smile. Chlorhexidine swabbing at maintenance frequency, combined with periodic dental prophylaxis, may offer an effective and pragmatic long-term preventive regimen for persons with disabilities.

Pain management in school-aged children by private and public clinic practice dentists.

A mail survey of 198 Seattle dentists who treat children assessed their beliefs about pain control in school-aged children and examined the relationship of those beliefs to pain management behaviors. The survey population of general dentists and pediatric dentists in clinics and private practice had a response rate of 89.6%. Two of three dentists always use local anesthetic when doing restorations or extractions and also provide more anesthetic at the child's request. One in three dentists never provides postoperative medication following tooth extractions. Ten percent regularly deny child pain and many do not believe child pain reports are valid. Dentists who work in private practice are more likely to provide local anesthetic than are dentists who work in clinics. Dentists who desire more control over a child are less likely to provide local anesthetic. Dentists who question children about comfort are more likely to provide additional anesthetic based on a child's report of discomfort and to provide postoperative medication if the dentist perceives a dental procedure to be painful.

Comparative quantitation of abscisic acid in plant extracts by gas-liquid chromatography and an enzyme-linked immunosorbent assay using the avidin-biotin system.

In this report we describe an enzyme-linked immunosorbent assay (ELISA) for the quantitation of abscisic acid (ABA) in plant extracts. A microtitration plate is coated with an ABA-protein complex. The ABA, standard or sample, is then added to each well with a limiting quantity of rabbit anti-ABA antibodies. During the following incubation period, antibodies bind either to free or to bound ABA on the plates. After washing, bound antibodies are indirectly labelled in two steps by the means of biotinylated goat antirabbit immunoglobulin-G antibodies which act as a link between rabbit anti-ABA antibodies and an avidin-alkaline phosphatase complex. The relative enzyme activity bound is measured spectrophotometrically. The detection limit of this method is 5 pg ABA and the measuring range extends to 10 ng. Gas-liquid-chromatography controls, with an electron capture detector, show a good correlation with ELISA results obtained using extracts of Lycopersicon esculentum, Nicotiana tabacum and Pseudotsuga menziesii samples purified by high-performance liquid chromatography. This provides a good argument for the accuracy of the immunoenzymatic method. The indirect labelling of antibodies, with the avidin-biotin amplifying system, should make this technique suitable for the quantitation of other plant growth substances against which specific antibodies are available.