Current opinion in dentistry最新文献

Mixed dentition treatment is an important subject because early treatment could not only correct the occlusion but also may ensure normal development of the teeth. Proper arch form and dental relationships in the mixed dentition lessen the need for additional orthodontic treatment. The objectives in mixed dentition orthodontic therapy are to correct dental arch irregularities, occlusal and jaw relation abnormalities, and to eliminate functional interferences.

With the decline in dental caries, the dental profession and the general public have become sensitized to the "new" specialty of cosmetic dentistry. As a consequence, research in the field of dental materials for the ideal, most natural restorative materials and techniques has become a primary focus and has had a profound influence on dental education and practice. This brief article will highlight some of these newer concepts.

Access to dental care is not equitable in the United States. The dental health of the population varies widely by socioeconomic status. Private dental insurance coverage has peaked at about 40% of the population, and benefits are variable. Dentistry is not included in Medicare and is optional for adults under Medicaid. Inflation is greater than for all goods and services. There is considerable administrative waste, and quality is variable. In this author's opinion, only a national system with universal coverage, one set of benefits, a single payer, a cap on expenditures, and no participation by insurance companies that is increasingly based on salaried consumer-or community-owned group practices with dentist input into decision making can hope to solve the existing problems.

Rapid progress has been made in the field of temporomandibular joint (TMJ) surgery during the past decade. These developments are predominantly due to the ongoing refinement of imaging and operative techniques. Parallel to these changes, the new techniques of arthroscopic surgery have been introduced into standard therapy for internal derangement and osteoarthrosis, to some extent. Several earlier studies have shown that open and arthroscopic surgery have similar success rates. Therefore, the surgeon has to decide which method would combine the smallest risk of postoperative morbidity with the least operative effort. In this regard, arthrocentesis is inaugurated as a new operative method for treatment of the closed lock. However, the basic concepts of arthroscopic surgery seem to be contradictory to the concepts of open surgery, which have also been proven successfully. Thus, the success of arthroscopic methods challenges our understanding of the pathogenesis and pathophysiology of internal derangements and osteoarthrosis of the TMJ. Today, morphologic findings from either arthroscopy, magnetic resonance imaging and new findings in the field of joint physiology lead to plausible explanations for the etiology and symptomatology of internal derangements. This is discussed in several papers. Additionally, arthroscopy may very well be an appropriate method of investigating intra-articular changes in the TMJ caused by trauma. So far, our knowledge about these effects still seems to be insufficient. For several years, the literature has reflected an increasing discussion about alloplastic materials used for interpositioning in the TMJ. A more rational approach in estimating the potential risks of these materials seems to be highly necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

The basic treatment objectives in the management of patients with dentofacial deformities have remained unchanged. However, there have been significant advances in the evaluation and treatment planning of these patients. These advances can be divided into two major categories: the incorporation of concomitant or delayed adjunctive aesthetic procedures; and the treatment of select patients in an ambulatory setting. These advances have objectively improved postoperative results and patient comfort and have reduced the costs of traditional inpatient surgery. This article reviews the recent literature relative to both of these categories.

It has been assumed that the principal changes that occur in the oral flora during cancer therapy are yeast and gram-positive coccal proliferation. Recent studies have shown that treatment with topical antifungals or disinfectants has failed to relieve such complications as irradiation mucositis that occur during anticancer therapy. Thus, many of the oral lesions observed during treatment are not due to candidiasis or streptococcal infection. It has been shown that anticancer therapy impairs or reduces the carriage defense of the oropharynx and is accompanied by colonization and proliferation of gram-negative bacilli. It is argued that if oral infectious complications are to be prevented during anticancer therapy, then the selective elimination of gram-negative bacilli may be indicated.

Administration of antimicrobial prophylaxis is advocated in procedures with a high risk of surgical wound infection. Recent advances in knowledge in this area include the broader recognition of risk factors that better predict the expected incidence of postoperative surgical wound infection than does the traditional wound classification system. In oral surgery, guidelines for antimicrobial prophylaxis based on established principles exist in the literature, and antimicrobial prophylaxis has been demonstrated to be effective in preventing postoperative surgical wound infection. However, surveys suggest that fundamental principles are often ignored, and antibiotics are often initiated at an inappropriate time and are continued beyond the time required to be influential on reduction of infection rates.

There have been significant advances in the diagnosis and treatment of impacted third molars with special emphasis on periodontal health in the second molar area adjacent to the extraction site. A thorough discussion addresses these advances and their impact on treatment planning of asymptomatic impacted third molars.

The current trend in antibiotic prophylaxis for prevention of endocarditis is toward more simple, effective regimens to promote better patient and dentist compliance. All national medical groups are now recommending oral regimens for all at-risk patients, and most of these groups recommend single-dose oral regimens. The Swiss Working Group recommends multiple-dose amoxicillin for high-risk patients. The American Heart Association recommends two-dose oral regimens for all at-risk patients. Clindamycin appears to be the second drug of choice. The many pharmacokinetically different erythromycin preparations and the high rate of intolerance to many of these preparations has led to this change. No national or international medical groups recommended prophylaxis for patients with prosthetic joints. Most reviews conclude that there is little or no scientific evidence to support this use. It is time to stop the practice of prophylaxis for patients with prosthetic joints. The only patients with joint prostheses who should even be considered for prophylaxis are those patients considered at "high" risk.

Progress in laboratory investigation of the biologic basis of osseointegration coupled with an extensive world-wide clinical experience have created a better understanding of implant and tissue integration and has allowed expanded clinical applications. Techniques are now available to provide alloplastic tooth replacements that are biomechanically stable and predictable and provide adequate masticatory, phonetic, and esthetic function approximating that of the normal dentition. Computed tomography is now used to assist the surgeon in determining available recipient bone sites and to determine the exact three-dimensional positioning of endosseous implants in the jaw bone. Surgical management of bone volume deficiencies, utilizing grafting techniques with bone and bone substitutes and guided tissue regeneration with membrane barriers, have given previously rejected patients an opportunity to benefit from osseointegrated implants. Congenital and acquired bone defects may now be managed and reconstructed with techniques that include dental implant surgery. Osteoinductive and osteoconductive substances are now available to assist in accelerating healing and present great promise for future applications.