[Dental health and the combat readiness].

Oral diseases are still amongst the most common human ailments in the western world and in Israel. Acute dental illness may cause intense pain, malaise, nutrition impairment, disturbance and loss of operative activities. The article reviews the literature from the last two decades regarding dental classification of military service candidates, incidence of acute dental conditions and emergency treatment needs in military population, and dental preparation programs for military recruits.

[Military aviation dentistry].

The aim of this article is to introduce the concepts of military aviation dentistry, including facial barotraumas (external otitic barotrauma, barosinusitis and barotitis- media), dental barotrauma, barodontalgia, and dental care for aircrews. Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. The article supplies the military dental officer with diagnostic and treatment guidelines, and the principles of prevention, periodic examination, and dental-related flight restriction.

[Rational antibiotic therapy in the dental office: Practical guidelines for decision-making].

Although most dental and periodontal diseases are caused by bacteria, the usual therapy is mechanical/surgical rather than antimicrobial medications. However, sometimes antibiotic administration may be necessary in addition to or as an alternative to the surgical/mechanical treatment. Many studies have shown that the misuse of antibiotics by dentists may be mostly attributed to unnecessity or inefficient regimen, and could contribute to bacterial resistance to antibiotics. The article presents practical guidelines to the administration of antibiotics in the dental office.

[Oral carcinoma: From awareness to survivorship].

Oral and oropharyngeal cancer is amongst the most common and fatal malignant diseases worldwide, with oral squamous cell carcinomas constitute more than 90% of all lesions. This article follows the oral cancer patient from the point of view of the oral medicine practitioner; from the stage of the potentially malignant disorders to the diagnosis of cancer, to the management of short-term comlications of the cancer therapy, to the stage of long-term follow up and management of lifelong oral complications of the oncologic treatment.

Oral and maxillofacial pathologies in young- and middle-aged adults.

OBJECTIVE: To evaluate the distribution of oral and maxillofacial pathologies (OMFPs) and its association with patient age in young- and middle-aged adults. METHODS: Distribution of histopathologically diagnosed OMFPs (n = 385) treated during 2007-2010 was recorded and the association with patient age was retrospectively analyzed. RESULTS: The main diagnostic categories included benign exophytic lesions (45.3%), white benign lesions (13.5%), potentially malignant lesions/disorders (10.1%), intrabony lesions (9.8%), mucosal discoloration (7.8%), benign pigmented lesions (7.3%), chronic trauma/inflammation (3.9%), and oral malignancy (2.1%). Potentially malignant lesions/disorders as a diagnostic category were positively associated with age (OR = 1.07 for 1 year; P < 0.001) and specifically the diagnoses of oral lichen planus (OR = 1.04 for 1 year; P = 0.037) and dysplastic changes (OR = 1.08 for 1 year; P = 0.013) that comprised this category. Pigmented melanocytic lesions were negatively associated with age (OR = 0.94 for 1 year; P = 0.039) as well as benign/reactive exophytic lesions (OR = 0.98 for 1 year; P = 0.038), the latter included the histopathological diagnosis of benign salivary gland pathologies (OR = 0.90 for 1 year; P < 0.001). CONCLUSION: This study provided baseline information regarding the distribution OMFPs among young- and middle-aged adults. It is important to highlight the high frequency of potentially malignant lesions/disorders and oral malignancy in young- and middle-aged adults, as these lesions require lifelong follow-up.

[Introduction to the Hebrew edition of the guidelines for the management of traumatic dental injuries by the International Association of Dental Traumatology].

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. As a part of the IADT global effort to provide accessibility to these guidelines worldwide, we present here an Hebrew version of the official IADT guidelines.

[The influence of barometric pressure changes in the oral cavity: dental barotrauma and barodontalgia].

Several oro-facial physiologic and pathologic phenomena affect individuals during flight or self-contained underwater breathing apparatus (SCUBA) diving. Physicians and dentists who treat aircrews and divers are occasionally challenged by those manifestations, though their uncommon appearance. This article reviews the two main barometric-related phenomena in the oral cavity: dental barotrauma and barodontalgia. Dental barotrauma includes all barometric-related dental mechanical phenomena. Tooth fracture or failure of dental restoration usually appears in a tooth with a leaking restoration or secondary caries lesion. In addition, changes in barometric pressure can cause a reduction in the retention of dental restoration and appliance. Barodontalgia is the oral pain which evoked during changes of the atmospheric pressure. This manifestation can be classified as a direct or non-direct pain. In most cases, the direct pain is caused by deterioration of pre-existed oral disease, whereas the source of the nondirect pain is an extra-oral facial barotrauma. These two barometric-related manifestations can cause a decrease in life quality and jeopardize the safety of flight or diving.

Colonization of Candida: prevalence among tongue-pierced and non-pierced immunocompetent adults.

OBJECTIVE: To evaluate the colonization of Candida at the tongue-piercing site of immunocompetent individuals. SUBJECTS AND METHODS: Swabs samples were obtained from the anterior lingual mucosa of healthy young adults with tongue piercing (N = 115); 86 subjects with (non-intra-oral) facial piercing served as a comparison group. Candida colonization was examined by light microscopy after 5-day incubation. Positive specimens were re-cultured on Chromagar Candida plates for species identifying. RESULTS: Candida colonization was more prevalent among tongue-pierced (20.0%) than facial-pierced subjects (9.4%; P = 0.048). All colonies were of Candida albicans. No difference was found between current tongue ornament wearers (21.2%) and non-wearers (19.5%; P = 0.803). In multivariate analysis, the only significantly positive influencing factors on colonization were tongue piercing (P = 0.034) and daily smoking of more than 10 cigarettes (P = 0.024). CONCLUSIONS: Piercing of the tongue was found to be a risk factor for colonization of Candida albicans, without an influence of whether or not an ornament is in place.

[The new IADT guidelines for dental trauma management: an introduction for the Israeli dentist].

Dental trauma is, unfortunately, not uncommon in the Israeli population. High risk populations include children, sport participants, military personnel and patients with oral (tongue) and/or lip piercing. In 2007, the International Association of Dental Trauma (IADT) updated the guidelines for the management of traumatic dental injuries. This paper is aimed to discuss and present the new guidelines for the management of traumatic dental injuries and to offer some highlights to the Israeli dental population. Good prognosis of injured teeth largely depends on prompt and appropriate management. Thus, it is important for healthcare-givers, especially dental practitioners, to maintain an adequate level of updated knowledge.

Oral self-care habits of dental and healthcare providers.

OBJECTIVE: To evaluate the self-care level of dental and healthcare providers regarding prevention of oral diseases METHODS: Healthcare providers (dental assistants and surgeons, laboratory personnel, biologists, medics, paramedics, corpsmen, nurses, pharmacists, physicians, physiotherapists, psychologists, social workers, speech therapists, X-ray technicians) and non-health care providing adults (the general population) were asked to respond to a questionnaire regarding their routine measures for maintaining oral health. RESULTS: Three hundred and twenty-six healthcare providers and 95 non-healthcare providers participated in the study. Regarding toothbrushing, flossing, undergoing periodic dental examinations and professional scaling/polishing, dental practitioners have better, but not perfect, maintenance habits than other healthcare providers. Non-dental healthcare providers have better dental habits than the general population, and nurses and medical practitioners have better dental habits than medics, paramedics, corpsmen and para-medical professionals. Among non-dental healthcare providers, nurses have a relatively high frequency of toothbrushing and flossing but a low frequency of periodic examinations and scaling/polishing. Generally, females reported significantly higher frequencies of toothbrushing and flossing than males did. The toothpaste selection of the participants was primarily influenced by dentists' recommendations, the flavour of the toothpaste, and its anti-malodour effect were the most dominant factors. CONCLUSION: The compliance of health professionals, especially dental practitioners, with appropriate oral health measures is relatively high. However, the dental team cannot always assume that the dental patient, who also happens to be a healthcare provider, has meticulous oral habits. The dental hygienist and surgeon have to educate and motivate their patients, especially healthcare providers because of the influence of the latter on their own patients.

[Hidden occlusal caries lesion--a diagnostic challenge].

In the 1980s a new type of caries lesion was added to the lexicon of Dentistry, namely, the Hidden Caries. The hidden caries is a sub-type of the occlusal pit and fissure caries type, and is defined as a dentinal caries lesion nearby the occlusal surface of the tooth, seen on a radiograph, where the occlusal enamel remains intact or is minimally perforated. The cariogenic bacteria penetrate into the enamel via a minimal hole in the enamel surface, but once reaching the softer dentine, their progression is less restricted, and meanwhile the fluoridated enamel undergoes remineralization thus covers the traces. Hidden caries lesions challenge the dental surgeon in diagnosis, treatment planning and research, in particular because of their 'hidden' nature. The potential diagnostic errors regarding hidden caries are undiagnosing, false-positive diagnosing, and misdiagnosing. The article reviews and demonstrates the differential diagnosis of a radiolucent spot on the occlusal dentin layer in posterior bitewing radiograph.

[The effectiveness of glass bead sterilizer in the dental practice].

OBJECTIVES: Although it is not FDA-approved as inter-patients sterilization measure, in Israel, glass bead sterilizer is still a common method for chair-side sterilization of small dental hand instruments, especially endodontic files. Studies from the 1950-1970s achieved sterilization by the bead sterilizer within few seconds. Nevertheless, there are no current evidence-based instructions for using this sterilizer. The study was designed to evaluate the effectiveness of this method in sterilization of endodontic files, according to current microbiologic knowledge. METHODS: Standard endodontic k-files (#15, 50, 80) were sterilized in a steam autoclave and then soaked in Actinomyces israelii, Eikenella corrodens or Bacillus cereus [0.5 MacFarland] media for 10 sec. After drying, the files were placed in 225 degrees C or 250 degrees C-heated glass bead sterilizers for 0, 15, 30 or 60 sec. After appropriate incubation for 10 d, morphologic and biochemical examinations were performed to reveal bacterial growth. RESULTS: Files that have been contaminated with A. israelii were sterilized within 30 sec, whereas B. cereus and E. corrodens-contaminated files needed 60 sec for sterilization. CONCLUSIONS: The use in bead sterilizer has to be limited only for sterilization of intra-appointment purpose. However, it seems that the common method of using bead sterilizer for sterilization time of few seconds is not effective. In order to eliminate spore-forming bacteria, like B. cereus, by bead sterilizer, the sterilization time has to be at least 60 sec. More research is needed, however, for establishing the effectiveness of the bead sterilizer for viral infection control and for other dental instruments.

[Ethnic origin and alveolar bone loss in Israeli adults].

BACKGROUND: The aim of this study was to evaluate the association of alveolar bone loss and ethnic origin among Israeli adults. METHODS: The study population consisted of 815 male military personnel, aged 25 to 60 years (average 38.1 +/- 7.0 yr), who arrived at a military dental clinic for routine dental examination during 2004-5. The distance between CEJ and alveolar bone crest was measure on pair of standardized posterior bitewing radiographs. Associations between the periodontal score and place of birth, the father ethnic origin and the mother ethnic origin were evaluated using the chi2-test. RESULTS: The individual's place of birth had no influence on the radiographic alveolar bone loss. Father of Yemenite-, North-African- or Mediterranean-origin, and mother of Yemenite-, North-African- or Asian-origin have associated to the occurrence and severity of alveolar bone loss, whereas sons to father or mother from Israeli or European descent were found to have less bone loss (p < 0.001). CONCLUSIONS: Ethnic origin has an influence on the alveolar bone loss in Israeli adults. However, more research is needed on the role of the potentially confounders in the association between origin and periodontal health.

[Intra-oral and peri-oral piercing].

Oral Piercing is a practice that is gaining acceptance in the western world as a sign of individuality, marginality, decoration, or group membership. In a recent large-scale survey among Israeli young adults, more than half of the study population was not aware of any of the complications of oral piercing. Pain, bleeding, edema, inhalation, dental and gingival trauma, allergic reaction, contact lesions, impaired mastication, deglutition, and speech, are all potential complications of intra-oral and peri-oral piercing. Piercing can induce local as well as distant site infection and inflammation such as Ludwig's angina, endocarditis and cerebellar abscess. Moreover, Piercing is recognized as a potential vector of viral transmitting. Nevertheless, not all piercers have adequate knowledge in infection control techniques. With the increase number of patients with pierced intra and peri-oral sites, dentists should be prepared to address issues, such as potential damage to the teeth and gingival, and risk of oral infection that could arise as a result of Piercing, as well as provide appropriate guidance to patients contemplating body piercing that involve the oral sites. Since common knowledge is poor, patients should be educated regarding the dangers that may follow Piercing of the oral cavity.

[Decision making of Hebrew University and Tel Aviv University Dental Schools graduates in every day dentistry--is there a difference?].

This study was designed to evaluate decision-making among Jerusalem Hebrew-University and Tel Aviv University dental schools graduates in various restorative dentistry, endodontics and oral surgery issues. A survey was conducted among 52 dentists during a dental military convention. Most of the dentists stated they will not recommend of re-treatment of endodontic-treated tooth with asymptomatic peri-apical pathology that does not need further rehabilitation. The study reveals over treatment and over-medication in restorative and surgery decisions. More than half of the dentists decided to treat caries lesions that extend to the dentino enamel junction, in low and moderate caries risk patients. More Hebrew University graduates than Tel Aviv University graduates recommend of removal of asymptomatic horizontal fully impacted mandibular third molar and disease-free maxillary third molar antagonist. Most of Tel Aviv graduates routinely prescribe antibiotic coverage after complicated tooth extraction. This study supports the need for continuing education on daily performed dental procedures.

Breaking confidentiality survey.

Several Israeli laws require therapists to violate confidentiality. Psychiatrists, clinical psychologists and social workers were asked about their decisions to break confidentiality concerning information revealed in psychotherapy. No differences were found in confidentiality between private practice and public services. No differences were found between the three professional groups. Many therapists claim they do not report sensitive information revealed in psychotherapy, and prefer dealing with the information in therapy. Therapists were less inclined to break confidentiality about past (as opposed to present) sexual abuse. Therapists were less inclined to break confidentiality when sexual abuse was revealed in psychotherapy by the abuser than when revealed by the victim.

The importance of a thorough medical and pharmacological history before dental implant placement.

The risk of osteonecrosis in patients treated with bisphosphonates is well known and guidelines intended to prevent this complication have been established and accepted. Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a unique condition in which even past administration of medication may be of current and future relevance. We present a case of BRONJ in the maxilla after dental implant placement. The patient suffered from osteoporosis and had been treated with oral alendronate sodium in the past. However, the medication was stopped two years before implant placement, and the treating dentist was unaware of the patient's past bisphosphonate use. Prevention of BRONJ is based on identifying at-risk patients, and then avoiding or modifying dentoalveolar surgical procedures in these individuals. Nevertheless, there seems to be some difficulties identifying patients at risk. We present some of the challenges that impede thorough assessment of a patient's medical background (review of systems) in the dental office, and suggest possible solutions.