Quintessence International, 07/1999

Recently, the World Wide Web has emerged as a platform for computer-based oral health records. Web-based patient records can make teledentistry an instant reality. Because an increasing number of dental care providers can access Web pages, traditional barriers to exchanging information are dropping. Web-based records also make cumulative, longitudinal patient records possible. Sophisticated security mechanisms can ensure the integrity and confidentiality of patient information. Because Web-based systems are simpler to install and configure, the cost of operating them may be reduced. However, their development is complex, difficult, and expensive because the Web was not developed as a programming environment. Furthermore, the technologies underlying the Web are constantly evolving, forcing developers to continuously reengineer their systems. In addition, several policy questions, such as storage of and access to computer-based patient records, have to be answered. This article describes CMSWeb, a Web-based clinical information system implemented at Temple University School of Dentistry.

A broken anesthetic needle is a rare complication in clinical practice. This article reports on 5 patients referred for removal of broken needles. The needles were located in the pterygomandibular space or near the maxillary tuberosity. These complications were the result of an unexpected movement by the patient or an incorrect anesthetic technique. The article also describes the case of a patient in whom an image observed in a routine panoramic radiograph could have been caused by a broken needle.

The numbers of patients using medications that induce gingival overgrowth are expanding rapidly. The tremendous increase in the number of organ transplants being performed, each requiring treatment with the immunosuppressive drug of choice, cyclosporine, has created a new dilemma in management of the gingival tissues. Additionally, cyclosporine-induced hypertension is frequently treated with calcium channel blockers, such as nifedipine, both drugs acting synergistically to induce gingival overgrowth. At present, the profession lacks a well-defined and easy-to-use clinical index for classifying overgrown gingival tissue. This article describes a comprehensive, yet simple, scoring system for enlarged tissues that may provide direction to the clinician and standardize evaluation. This system may also give guidance for the most appropriate time for surgical treatment of drug-induced gingival overgrowth.

This article provides an in-depth review of the literature on mucogingival surgical techniques. Indications and contraindications of various surgical procedures are discussed with reference to the literature. Surgical techniques and indications for increasing the zone of keratinized tissue, such as free autogenous grafts, applications of freeze-dried skin, and dermal matrix allografts, are described. Procedures to attain root coverage, such as various autogenous grafts and guided tissue regeneration techniques, along with application of chemicals such as citric acid to improve their success, are also described.

Objective: This study investigated the incidence and severity of postoperative sensitivity, examining several potential sources of pain. Method and materials: One hundred eighteen subjects were asked about pain that they experienced following an appointment for restoration of a moderate Class I or II carious lesion. The survey required subjects to complete 3 questionnaires, 1, 4, and 7 days posttreatment. Questions covered 9 different potential sources of postoperative pain and the use of pain medication following the dental appointment. Results: A great majority of subjects experienced postoperative pain from at least 1 source, and approximately half of those who reported pain following the appointment found it necessary to take medication for relief. For almost all categories, the level of pain reported at 4 and 7 days was substantially less than that reported after 24 hours. Conclusion: Patients commonly experience pain in the first 24 hours after operative treatment. Dentists should consider recommending that patients who are likely to experience postoperative pain take a nonprescription analgesic around the time of the treatment and for 24 hours afterward to prevent discomfort.

Objective: The search for the ideal polishing agent for resin composite materials is still ongoing. A new polishing brush with abrasive bristles for polishing resin-based restorations was tested to determine if it polishes restorations, including those with concave surfaces, macrostructured occlusal surfaces, and textured surfaces, without destroying their delicate texture or microstructure. Method and materials: The polishing effectiveness and the ultimate destructive potential of these brushes were assessed quantitatively and subjectively in vitro. In addition, the durability of the brushes after repeated use and autoclaving was also evaluated. Results: The brushes were nondestructive to resin-based restoratives, enamel, dentin, and the restoration interface. They produced a shiny surface on resin-based restorative materials without destroying the surface texture. The abrasive brushes were autoclavable and demonstrated satisfactory durability, despite multiple heat sterilization cycles. Conclusion: These brushes can be considered to be key products to polish concave surfaces, anatomically shaped occlusal surfaces, and textured surfaces without damaging the surface characteristics.

Objective: Many fluoride-releasing dental materials are being sold on the basis of their cariostatic properties. However, the amount of fluoride release of these materials is still uncertain. The aim of this study was to determine the amount of fluoride uptake in primary and permanent tooth enamel from 1 conventional glass-ionomer cement (Fuji II), 1 resin-modified glass-ionomer cement (Fuji II LC), and 2 fluoride-releasing dentin bonding agents (Liner Bond 2 and Optibond) in vitro. Method and materials: One hundred sixty caries-free primary and permanent molar teeth were assigned to the study. Materials were applied according to the manufacturer's instructions to standard windows created on the enamel surfaces. The amount of fluoride uptake by enamel was investigated by using a specific fluoride electrode and acid-etching biopsy technique. Results: The amount of fluoride taken up from Fuji II and Fuji II LC by permanent and primary tooth enamel was found to be statistically significant. However, no significant fluoride uptake from Optibond and Liner Bond 2 was found. Conclusion: Fuji II and Fuji II LC glass-ionomer materials seemed to provide more effective fluoride release than did Optibond and Liner Bond 2 in permanent and primary enamel.

Objective: With dental bonding systems that require acid etching of dentin, inadequate adhesive penetration can leave exposed collagen at the dentin-adhesive interface. The exposed collagen could be degraded by bacterial proteases, compromising the integrity of the dentin-adhesive bond and, ultimately, the restoration. The purpose of this study was to develop a nondestructive staining technique to identify exposed collagenous protein at the dentin-adhesive interface. Method and materials: The following adhesives were placed, according to manufacturer's instructions, on dentin cut from 15 human third molars: Scotchbond Multi-Purpose, Scotchbond Multi-Purpose Plus, and 3M Single Bond. Light microscopic sections of native dentin-adhesive interfaces of each tooth were cut and stained with Goldner's trichrome. This reagent stained exposed protein in the sections a distinct red-orange. Results: Exposed protein was identified at the dentin-adhesive interface with each of the adhesives. Corollary scanning electron microscopic examination confirmed the presence of exposed protein, ie, protein that was removed by sodium hypochlorite, at the interface. Sites of exposed protein that were clearly identified in the light microscopic sections were obscured in the transmission electron microscopic sections. Conclusion: In vitro identification of inadequacies in the dentin-adhesive bond is the first step in determining sites that may be vulnerable to premature breakdown under clinical conditions.