Irrigation trends among members of the Chilean Endodontic Society

Introduction: the aim of this study is to determine the current trends of irrigation during root canal therapy by specialists who are members of the Chilean Endodontic Society. materials and method: a survey (survey monkey -SurveyMonkey.com) was e-mailed to the 485 members of the Chilean Endodontic Society. the instrument was translated and adapted from the survey "irrigation trends among American Association of Endodontists members: a web-based survey" applied in the USA in 2012. participants answered a set of 16 questions that included irrigant selection, irrigant concentration, the adopted protocol, techniques or devices for irrigant activation. results: 99 percent of respondents use sodium hypochlorite as the main irrigant. data indicate that 74 percent of respondents use hypochlorite at a concentration of 5 percent. most respondents (94 percent) also include EDTA in their usual practice. In addition, 90 percent of respondents reported that they activate the irrigating agent, and 94 percent confirmed that they perform a final irrigation protocol. conclusion: the majority of respondents use sodium hypochlorite as the main irrigant at a concentration of 5 percent, use ethylenediaminetetraacetic acid (EDTA) as a smear removal agent, activate the irrigant, and perform a final irrigation protocol.

Tratamiento del liquen plano oral. Revisión sistemática y protocolo de actuación / Treatment of oral lichen planus. Systematic review and therapeutic guide

En la presente revisión sistemática se analizaron 55 artículos estructurados sobre la eficacia terapéutica frente al dolor y a los signos clínicos del liquen plano oral (LPO). La búsqueda bibliográfica se elaboró siguiendo los criterios del sistema PRISMA, seleccionando los ensayos realizados mediante alguno de los siguientes diseños metodológicos: entre fármaco (principio activo) vs. mismo fármaco en diferente excipiente o concentración, fármaco vs. diferente principio activo, fármaco vs. fitoterapia y fármaco vs. tratamiento con fototerapia. Basándonos en los resultados se propone un algoritmo que sirva de guía para establecer el tratamiento del LPO en sus formas clínicas atrófica y erosiva. Se destaca el empleo del propionato de clobetasol al 0,025-0,05% de aplicación tópica como primera alternativa terapéutica. En segundo lugar, el tacrolimús al 0,1% y pimecrolimús al 1% también formulado para su pauta tópica. Y, finalmente, se aborda el empleo de corticosteroide sistémico y la aplicación de láser de diodo (AU)

In this systematic review, 55 structured articles on the therapeutic efficacy against pain and clinical signs of oral lichen planus (OLP) were analysed. The literature search was developed according to the criteria of the PRISMA system, selecting the tests performed using one of the following methodological designs: drug (active ingredient) vs. drug in different excipient or concentration, drug vs. different active principle, drug vs. phytotherapy and drug vs. treatment with phototherapy. Based on the results, an algorithm is proposed to guide the treatment of OLP in its atrophic and erosive clinical forms. The use of clobetasol propionate at 0.025-0.05% of topical application as the first therapeutic alternative is highlighted. Secondly, 0.1% tacrolimus and 1% pimecrolimus also formulated for its topical regimen. And finally, we address the use of systemic corticosteroids and the application of diode lasers (AU)

Antibiotic-prescribing habits among Norwegian dentists: a survey over 25 years (1990-2015).

Bacterial antibiotic resistance is a steadily growing global problem, which today is compared with issues such as global warming, ozone depletion, and extinction of species. Consequently, calls come from global, Pan-European, and national authorities to gain insight into, limit, and stringently qualify the use of antibiotics in human and veterinary medicine, as well as in food production. Dentists are not considered to be frequent prescribers of antibiotics. However, few studies have identified how much, and in which situations, dentists prescribe such drugs. The aims of the present study were to survey Norwegian dentists' antibiotic-prescribing habits in 2015 and to compare the findings with previous studies (1990 and 2004) and with the actual numbers of dispensed prescriptions obtained from the 'Norwegian National Prescription Register'. The results from 1990 to 2004 show that there was a general increase in antibiotic prescriptions by Norwegian dentists, followed by a reduction or flattening of the prescription volume curve from 2004 to 2015. Despite this, possibilities for further improvements have been identified and recommendations given for targeted campaigns to reduce the prescription volume in dentistry by a further 30%, which has been ordered by the Norwegian National Assembly.

Prescribing patterns of analgesics and other medicines by dental practitioners in Australia from 2001 to 2012.

OBJECTIVES: Dental practitioners are able to prescribe a variety of medicines subsidized on the Pharmaceutical Benefits Schedule (PBS), the main categories of which are analgesics and antibiotics. We aimed to investigate the patterns of PBS prescribing of non-antimicrobial medicines by dental practitioners in Australia from 2001 to 2012. METHODS: Data were collected from Medicare Australia on prescriptions from dental practitioners dispensed to concessional beneficiaries between 2001 and 2012. We examined patterns of use over time. RESULTS: There was an overall increase in number of prescriptions and in dispensed use (standardized by dose and population) of analgesic medicines for the concessional population over the 12-years period. The use of dentally prescribed analgesics increased 15%, with use of nonsteroidal anti-inflammatory drugs increasing by 41% and opioid analgesics by 12%. Prescribing of the oxycodone 5-mg tablet increased 344% between 2005 and 2012, and dental prescription of the benzodiazepines diazepam and temazepam increased by 51% and 229%, respectively, over the observation period. Injectable corticosteroid use increased by 19%. Conversely, use of carbamazepine and anti-emetics decreased by 39% and 10%, respectively. CONCLUSIONS: Dental prescribing of analgesics, anti-inflammatories and benzodiazepines in the concessional population has increased significantly over the past decade. These data can form the baseline to further examine appropriate medicine use in the management of dental conditions.

The impact of pharmacy services on opioid prescribing in dental practice.

OBJECTIVES: To compare rates of dental opioid prescribing between periods of full and partial integration of pharmacy services and periods of no integration. METHODS: This observational study used a retrospective chart review of opioid prescriptions written by dental providers practicing in a free dental clinic for the medically underserved over a period of 74 months. Pharmacy services were fully integrated into the practice model for 48 of the 74 months under study. During this time frame, all dental opioid orders required review by the pharmacy department before prescribing. Outcomes related to prescribing rates and errors were compared between groups, which were defined by the level of integrated pharmacy services. Demographic and prescription-specific data (drug name, dose, quantity, directions, professional designation of individual entering order) and clinic appointment data were collected and analyzed with the use of descriptive and inferential statistics. RESULTS: A total of 102 opioids were prescribed to 89 patients; hydrocodone-acetaminophen combination products were the most frequently used. Opioid prescribing rates were 5 times greater when pharmacy services were not integrated (P <0.001); and dentists were 81% less likely to prescribe opioids when pharmacy was fully integrated (odds ratio 0.19, 95% confidence interval 0.124-0.293; P <0.001). Frequency of hydrocodone use compared with other opioids did not decrease after the rescheduling of hydrocodone to a Schedule II controlled substance. The frequency of prescribing errors was not statistically different between groups, although there were numerically fewer errors with integrated pharmacy services. CONCLUSION: The literature reports that dentists are the third most frequent prescribers of opioids. The findings from this study suggest that collaboration between pharmacists and dentists has the potential to decrease opioid utilization in primary dental practice.

[Medicines and oral healthcare 3. Insurance coverage and qualification to prescribe]. / Medicamenten en mondzorg 3. Vergoeding en bevoegdheid tot voorschrijven.

On the advice of the National Health Care Institute in the Netherlands and the institute's Board of Scientific Advisors, the minister of Health, Welfare and Sport decides whether a certain drug will or will not be included in the list of drugs covered by the basic health insurance plan mandated for all Dutch citizens. In making this decision emphasis is placed on the therapeutic value of that particular drug compared to that of the standard drug for that disorder, the impact that the inclusion of the drug would have on the budget and the drug's cost-effectiveness. In the case of disorders that do not respond or respond insufficiently to the standard treatment, however, one comes up against the limitations of this system and in some cases a necessary treatment is not reimbursed. With respect to prescribing medications, dentists are qualified to prescribe, provided they are enrolled in the so-called BIG register [that recognises the qualifications of healthcare professionals in the Netherlands]. Dental hygienists, by contrast, are not qualified to prescribe and have to limit themselves to at most recommending over-the-counter medicines. In prescribing medicines, dentists are of course limited to those about which they have comprehensive knowledge and sufficient experience. If a dentist wants to prescibe a drug that is outside his or her own experience, then he or she should consult with an oral and maxillofacial surgeon, general practitioner or medical specialist to determine whether the medication can be prescribed and if so, by whom.

Prosthodontic decision-making relating to dentitions with compromised molars: the perspective of Swedish General Dental Practitioners.

The aim of this investigation was to study the clinical prosthodontic decision-making process relating to dentitions with compromised molars among Swedish general dental practitioners (GDPs). Eleven Swedish GDPs were purposively selected, and all agreed to participate. Then, in-depth, semi-structured interviews were conducted and covered treatment considerations concerning two authentic patient cases, initially with complete dental arches, and later, a final treatment based on a shortened dental arch (SDA) was discussed. The cases involved patients with compromised teeth situated mainly in the molar regions. One patient suffered from extensive caries and the other from severe periodontal disease. Qualitative content analysis was used to analyse the data. In the systematic analysis, two main categories were identified: holistic and functional approach. Among the interviewed GDPs, focus was put on patients' needs, background history and motivation for treatment as well as the preservation of molar support. Within the limitations of this study, the following can be concluded: keeping a dental arch with molars seems to be important to Swedish general dental practitioners. The SDA concept does not seem to have a substantial impact on the prosthodontic decision-making relating to dentitions with compromised molars. The dentist's experiences, as well as colleagues' or consulting specialist advice together with aetiological factors and the patient's individual situation, influence the decision-making more than the SDA concept. The conflicting results in the prosthetic decision-making process concerning the relevance of age and the need for molar support need further investigation, for example based on decisions made in the dentist's own clinical practice.

Oral Infections and Pregnancy: Knowledge of Gynecologists/Obstetricians, Midwives and Dentists.

PURPOSE: To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants. MATERIALS AND METHODS: A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients. RESULTS: Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic. CONCLUSION: The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia.

An Overview of Preformed Metal Crowns. Part 1: Conventional Technique.

This article details the clinical techniques for conventional preformed metal crown placement. It aims to increase the readers' awareness of the clinical advantages of preformed metal crowns and the indications for their use. The second part will discuss the Hall Technique. CPD/Clinical Relevance: This two-part article aims to guide the reader through the conventional and alternative techniques available for placement of a preformed metal crown whilst providing an update of the evidence for each.

Manejo clínico odontológico integral del paciente con síndrome de Sjögren: Una propuesta / Integral dental clinical management of patients with Sjögren's syndrome: A proposal

El síndrome de Sjögren (SS) es una enfermedad autoinmune, crónica e inflamatoria caracterizada por infiltración de células plasmáticas y linfocitos en las glándulas exocrinas, particularmente en las salivales y oculares. La patogénesis del SS está relacionada con factores inmunológicos, neurológicos, genéticos, virales y hormonales. La deficiente calidad y cantidad de saliva trae consecuencias devastadoras para la salud dental y bucal, alteraciones del esmalte, caries en las superficies dentarias expuestas, principalmente cervicales, fallas en la adhesión de los materiales obturadores, queratosis en las mucosas, síndrome de boca urente y disconfort en el uso de prótesis dentarias, a pesar de un manejo exhaustivo del medio bucal. Un diagnóstico tardío del SS conlleva a graves consecuencias físicas, sicológicas y económicas en estos pacientes. Su diagnóstico y tratamiento son de gran interés para el odontólogo. La experiencia clínica señala que aquellas piezas dentarias restauradas con prótesis fijas tienen mayor sobrevida y la rehabilitación con prótesis implantosoportadas brindaría un mayor confort para los pacientes. La clínica odontológica debe tener un enfoque integral del daño y la forma de tratamiento debe considerarlos como pacientes de muy alto riesgo de caries basados en CAMBRA (Caries management by risk assesement). El manejo eficaz de la salud oral en estos pacientes comprende la mejora de la producción salival, preservación de mucosas orales y la evaluación periódica del estado bucal. Se propone un protocolo de atención odontológica integral que consta de tres fases: 1) Fase inicial, paliativa y preventiva; 2) Fase restauradora y rehabilitadora, y 3) Fase de mantenimiento (AU)

Sjögren's syndrome (SS) is an autoimmune, chronic and inflammatory disease characterized by infiltration of plasma cells and lymphocytes in the exocrine glands. The pathogenesis of SS is related to immune, neurological, genetic, viral and hormonal factors. Complications are related to glandular destruction and mucosal dryness. The poor quality and quantity of saliva brings devastating consequences to dental and oral health. Alterations in the enamel structure, constant presence of caries in tooth surfaces exposed, mainly cervical, failures in the adhesion of filling materials, keratoses on the mucous membranes, burning mouth syndrome and discomfort in the use of dentures, despite the exhaustive management of the oral environment, are described. A late diagnosis of SS leads to serious physical, psychological and economic consequences in these patients. Its diagnosis and treatment are of great interest to the dentist. Clinical experience indicates that those teeth restored with fixed prostheses have an improved survival and rehabilitation with implant-supported prostheses would provide greater comfort for patients. The dental clinic must have a comprehensive approach to injury and the form of treatment should be considered as patients at high risk of caries based on CAMBRA (Caries management by risk assesement). Effective management of oral health in these patients includes improving the production of saliva, oral mucosal preservation and regular assessment of oral status. A comprehensive dental care protocol consisting of three phases, is proposed: 1) Initial, palliative and preventive phase, 2) Restorative and rehabilitation phase, and 3) Maintenance phase (AU)

Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists.

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development.

INTRODUCTION: Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways. METHODS: A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development. RESULTS: The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper. CONCLUSIONS: Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.

Finishing and polishing procedures of composite restorations by Saudi dentists: a cross-sectional study.

AIM: The purpose of this study was to assess the knowledge and practices of Saudi dentists in finishing and polishing composite restorations. MATERIALS AND METHODS: A cross-sectional questionnaire-based study was conducted among 306 Saudi dentists from March to April 2012. The collected data were analyzed using Microsoft Excel 2010 program and descriptive statistics were obtained. RESULTS: Completed questionnaires were returned by 191 participants, giving a response rate of 62.4%. 115 (65.7%) respondents are using fine diamond finishing burs for finishing occlusal surfaces, 82 (48%) used fine aluminum oxide finishing discs for finishing facial surfaces, 130 (76%) used diamond finishing strips for finishing interproximal surfaces.121 (63.4%) respondents were of the view that the type of filler content has a major influence in providing color stability to the composite restoration and 137 (72.1%) believed nano-composites provided enhanced color stability. CONCLUSION: Dentists in Saudi Arabia are aware of the benefits of proper finishing and polishing of composite restorations. They however need to use finishing and polishing burs, disks, strips and pastes in a sequential series. Usage of composite polishing pastes and composite surface sealants should be emphasized in undergraduate curriculum.

Ohio dentists' awareness and incorporation of the dental home concept.

BACKGROUND: The authors measured the awareness of the dental home concept among pediatric dentists (PDs) and general practice dentists (GPs) in Ohio and determined whether they included dental home characteristics for children 5 years and younger into their practices. METHODS: The authors sent a pretested 20-question survey to all Ohio PDs and to a random sample of approximately 20 percent of GPs in Ohio. The authors designed the survey to elicit information about dental home awareness and the extent to which dental home characteristics were incorporated into dental practices. RESULTS: More than 90 percent of both GPs and PDs incorporated or intended to incorporate into their dental practices the specific dental home characteristics mentioned in 20 of 41 items related to dental home characteristics. Of the respondents who did not already incorporate dental home characteristics into their practices, however, most did not intend to do so. Less than 50 percent of respondents in both groups responded positively to some items in the culturally effective group, and GPs were less likely than were PDs to provide a range of behavior management services and to provide treatment for patients with complex medical and dental treatment needs. PDs were more likely than were GPs to accept Ohio Medicaid (64 versus 33 percent). PDs were more likely than were GPs (78 versus 18 percent) to be familiar with the term "dental home." More recent dental school graduates were more familiar with the term. CONCLUSIONS: Most Ohio PDs' and GPs' practices included characteristics found in the definition of dental home, despite a general lack of concept awareness on the part of GPs. Research is needed to provide an evidence base for the dental home. Practical Implications. Once an evidence base is developed for the important aspects of the dental home and the definition is revised, efforts should be made to incorporate these aspects more broadly into dental practice.

Routines for interocclusal appliance therapy among general dental practitioners in a Swedish county.

The aims of this study were to investigate what kind of interocclusal appliances that were chosen among Swedish dentists when treating temporomandibular disorders (TMD), the clinical rationale for the treatment, the diagnoses that warranted the appliance treatment, the use of adjunct TMD treatments and prognostic considerations, and possible differences in these respects between children/adolescents and adults with TMD, and, finally, possible differences between private practitioners and general practitioners in the public dental service. During the 12-months-period April 2009-March 2010 all general dental practitioners in the county of Jönköping, Sweden, were asked to fill in a questionnaire when performing a TMD treatment with an interocclusal appliance. A total of 394 questionnaires were filled in and returned, 216 (55%) from dentists in public dental service and 178 (45%) from private practitioners. It was found that in 40% of the cases, no pre-treatment recording of the functional status in the masticatory system had been made. The commonest reasons for the treatment were bruxism, headache, and replacement of a previous appliance. Less than half of the appliances made were hard acrylic appliances. Some kind of adjunct therapy had been made in 22% of the cases treated in public dental service. The corresponding figure for those treated by private practitioners was 25%. Therapeutic jaw exercises was the commonest adjunct therapy followed by selective occlusal adjustment. In the vast majority of cases, the dentists judged the prognosis of the treatment to be good. It is concluded that a large number of appliances made to treat TMD were soft appliances, especially in public dental service. This reflects a possible overuse of soft appliances at the expense of hard acrylic appliances. Furthermore, in a large number of cases, the treatment was performed without any pre-treatment registrations, and adjunct therapies were rarely used. In all these respects,there is an improvement potential for the treatment of TMD in general dental practice.

Are you treating planned cases or treating teeth to stay busy?

Responsible aesthetics and comprehensive care requires a thorough patient examination and evaluation of risk factors that help to prevent and curtail re-restoration and more aggressive tooth preparation. Managing identified risks that could potentially lead to otherwise piecemeal dental procedures keeps dentists treating comprehensively planned cases, not just teeth. Dentistry that is comprehensive, desired, and evidence-based is a valuable service to patients and a satisfying endeavor for dentists and their teams. By choosing between the sure thing of a quick fix and discussing what the patient wants, dentists can embrace a MI, responsible aesthetic approach to treatment planning, case acceptance, and most importantly, patient oral care.

Endodontic 'Solutions'. Part 2: An audit comparing current practice in Belfast with UK and Republic of Ireland Dental Schools.

UNLABELLED: Endodontic lubricants, irrigating solutions and medicaments help reduce the microbial load within root canals. Primary and secondary cases involve different microbes. Each'solution'or combinations thereof could play a significant role but no detailed guidelines exist on their use. An audit was undertaken to compare current practice in Belfast Dental School to the others across the UK and Republic of Ireland (ROI). This audit highlighted three main differences between Belfast and other dental schools. Many other institutions utilized other irrigants besides sodium hypochlorite (NaOCl), different intracanal medicaments, including calcium hydroxide, and higher concentrations of NaOCl. Having gathered this information, we ask, 'Is there sufficient evidence to change the endodontic regime currently used at Belfast Dental School?'. Using the findings from the literature review (Part 1), we introduce new evidence-based protocols for primary and secondary cases for use in Belfast Dental School. CLINICAL RELEVANCE: In the absence of detailed clinical guidelines on the use of endodontic lubricants, irrigants and medicaments in primary and secondary cases, it is important to be aware of current practice in UK and ROI dental schools where dentists and specialists are trained.

Outcomes of oral cancer early detection and prevention statewide model in Maryland.

A high oral cancer mortality rate and a moderately high oral cancer incidence rate prompted Maryland to develop a statewide approach to oral cancer early detection and prevention. This approach can serve as a model for other states. Key lessons learned include the need to: develop a comprehensive plan that focuses on actions to increase awareness, education and training for the public, dental and non-dental providers and policy makers; include oral cancer in the state's comprehensive cancer control plan to keep attention focused on this disease; and maintain high vigilance among stakeholders to keep oral cancer prevention and early detection a high priority within the state. Future efforts will focus on: requiring all dental and dental hygiene students to perform a set number of supervised oral cancer examinations for licensure to ensure a dental workforce that is competent and predisposed to providing routine oral cancer examinations; training health care providers such as doctors, nurse practitioners, and physician assistants to perform oral cancer examinations as part of a comprehensive cancer screening exam to expand the number of individuals that receive oral cancer examinations; and continuing to educate the public about oral cancer risk factors, its symptoms, and ways to prevent it.