Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)最新文献

This restrospective study is aimed at increasing the understanding of the relation of attention deficit/hyperactivity disorder (ADHD), attention deficit disorder (ADD), and hyperactivity to the various symptoms of sleep-disordered breathing (SDB) to aid in the diagnosis and implementation of treatment protocols for a child's cognitive function and emotional regulations. Increasing better sleep can enhance a child's success in school and may improve attention, behavior, and neurocognitive processes, which can contribute to the child's future health.

Materials and methods: The study comprised 665 patients from age 2 to 16 years with a mean age of 8.4 years, of which 54% were male and 46% were female. The incidence of ADHD was 29% while ADD alone was 7% and hyperactivity alone was 15%. A sleep questionnaire was issued to parents of the dental patients nationwide, and they were asked to fill it out after several nights of observing their child while sleeping. A numerical severity scale was used for each of the most common symptoms of SDB and consisted of a ranking from 1 to 5 (mild to severe). The symptoms plus their severities resulted in a sleep severity index. This data was used for the various statistical tests. A subsample of 220 cases was also used to determine treatment success with a preformed removable sleep modifying appliance.

Findings: ADHD was correlated with 78% of 27 SDB symptoms, while ADD occurring alone was correlated with 37%, and hyperactivity occurring alone with 56%. The symptoms most closely associated with ADHD were "nighttime mouth breathing" and "wakes up at night," and both symptoms were correlated with ADHD, ADD, and hyperactivity. An alternative condition to ADHD called DLRS ("doesn't listen, resists sitting still") was introduced that can verify the accuracy of ADHD.

Conclusion: ADHD was correlated with 78% of 27 SDB symptoms, "nighttime mouth breathing" was correlated with 90% of 29 SDB symptoms, and "wakes up at night" was correlated with 83% of 29 SDB symptoms.

While it is common practice in dentistry to treat individual teeth only as problems arise, recurrent failures may result if causation is not addressed. This case report details a comprehensive approach to the full-mouth rehabilitation of a patient who was dissatisfied with decades of restorative failures following reactive single-tooth treatment. A thorough review of the patient's medical and dental history along with a detailed clinical examination revealed an unstable bite, which had been contributing to the cause of her worn and fractured restorations. A systematic, sequenced restorative approach that addressed the patient's underlying occlusal dysfunction and enabled financial affordability was taken to achieve a long-lasting, predictable result.

Adhesive bonding is a critical step in prosthetic and restorative dentistry. Over the years, the evolution of adhesives and bonding systems has focused on simplicity, efficiency, and reliability in clinical practice procedures to achieve less-invasive, long-term, durable direct and indirect restorations.1 Recently introduced universal adhesives and resin cements offer easy-to-use options that combine the strengths of previous generations of bonding agents into a versatile, user-friendly one-step solution. However, it is important to define what constitutes a "universal" system and to critically assess whether these new systems truly meet the criteria.

The inadvertent ingestion or aspiration of dental instruments-particularly implant-related components-poses serious medical risks and legal implications. However, there is a lack of standardized protocols or professional guidelines for these adverse events. This article reviews current literature, highlights common preventive practices, and proposes a practical, step-by-step management algorithm. Emphasis is placed on early identification, emergency response, and, most importantly, appropriate referral to minimize patient harm. The authors, drawing from clinical and legal experience, advocate for ethical responsibility, improved intraoperative precautions, and standardized protocols to address this potentially fatal event in dental practice.

Oral diseases affect nearly 3.7 billion people worldwide,1 with conditions such as untreated dental caries and periodontal diseases impacting more than 2 billion and 1 billion individuals, respectively, thus imposing significant functional, social, and economic burdens. Despite the dental profession's progress in understanding the etiopathogenesis of dental caries and periodontal diseases, the global burden of these disorders remains high, with case numbers increasing due to population growth and aging. Unfortunately, this trend is expected to continue. Projections for the United Kingdom, for example, suggest that by 2050, over 60% of the adult population aged 60 or older will have untreated dental caries, and more than half will be affected by periodontal diseases. The expected increase in these conditions poses a threat to dentists' ability to provide curative care to all affected patients, highlighting the need to focus on actions toward health promotion and disease prevention.

While toothbrushing remains the primary technique recommended for mechanically removing plaque above the gumline, it often leaves interproximal plaque unaddressed. Cetylpyridinium chloride (CPC) is a well-known antibacterial for use in mouthwash formulas, demonstrated to successfully reduce plaque and gingivitis throughout the mouth. There is evidence, however, that the addition of zinc lactate to the formula increases its efficacy in vivo.

Various adhesive techniques and ceramic materials can be incorporated to create a biological, functional, and esthetic smile and occlusion. In this case report, a 37-year-old woman presented to a dental school clinic seeking treatment for missing teeth. She also was dissatisfied with the color of her existing teeth and desired a broader smile (buccal corridor). In addition, tooth No. 9 had external resorption and needed to be extracted and replaced. With a previous history of unsatisfactory orthodontic treatment, the patient declined orthodontics despite the benefits it could have provided. A multidisciplinary approach was taken to replace defective restorations, address missing mandibular teeth, and improve esthetics. Treatment involved at-home bleaching, implant placement, porcelain veneers, ceramic onlays, ceramic crowns, and bonded cantilever ceramic fixed dental prostheses (FDPs). Posterior occlusion would be established through the placement of ceramic onlays and crowns and posterior cantilever ceramic FDPs to restore her missing mandibular first premolars. Anterior esthetics were then enhanced by placing ceramic veneers and an implant-supported ceramic crown (No. 9). This article demonstrates the selection and use of various ceramic materials, the proper sequencing of the placement of each restoration, and appropriate adhesive application to achieve an esthetic, long-term result. It highlights the importance of proper planning for implant crowns in the esthetic zone, as the contouring of the provisional crown provides guidance to the laboratory for fabrication of the final restoration.

Alveolar bone loss threatens tooth stability and can lead to loss of function. When occurring in the esthetic zone, this can have acute social ramifications, decreasing the patient's quality of life. In the outlined case, a 65-year-old nonsmoking female patient with periodontitis presented with a periodontal defect in the anterior region, requiring bone regeneration. Treatment involved the application of an octacalcium phosphate-coated deproteinized bovine bone mineral consisting of 100% cancellous bone, along with adjuvant factors such as platelet concentrates and platelet-rich fibrin, to regenerate the atrophied ridge. The patient experienced uneventful healing with no documented complications. Long-term follow-up of 6.3 years revealed successful bone regeneration and stability. This case report demonstrates the long-term safety and reliability of xenograft material to support bone regeneration in a patient who was treated for alveolar bone loss due to periodontitis.

Clinical conditions known as desquamative gingivitis (DG) are characterized by erythema, ulceration, erosion, and blistering or desquamation of the marginal and attached gingiva, which can be localized or widespread. DG is a clinical description of oral lesions rather than a definitive diagnosis. In many common forms of DG, the initial presentation is typically desquamation or erosion on the labial surface of anterior teeth. Although DG may be caused by a broad range of local and systemic conditions, pemphigus vulgaris, oral lichen planus, and mucous membrane pemphigoid are the most common triggers. While DG does not directly cause attachment loss or alveolar bone destruction, it can lead to oral discomfort and impair proper oral hygiene, which poses a long-term risk to dental and periodontal health. Because many disorders associated with DG may involve systemic presentations, both oral and extraoral symptoms must be assessed. Further, some of these conditions demonstrate significant morbidity and, in some cases, lifethreatening complications. Given the wide range of possible manifestations and the complexity of diagnosis, identification and management of DG often requires a multidisciplinary approach to ensure optimal patient care. Initial recognition of DG and rapid identification of a definitive diagnosis is critical to ensuring patients' health and comfort. This article reviews the clinical characteristics, diagnostic approaches, and treatment protocols for mucocutaneous diseases associated with DG.

Dental implants have revolutionized contemporary dentistry by providing durable, esthetic, and functional solutions for tooth replacement. Their ability to osseointegrate with bone tissue enables stability and longevity to support a variety of fixed and removable prostheses. To ensure optimal implant success, including esthetics, phonetics, function, and resistance to periimplant disease, focus has shifted beyond osseointegration to the preservation and regeneration of surrounding hard and soft tissues. Oral regenerative procedures may be performed prior to surgical implant placement, simultaneous with implant surgery, and/or after implant placement or restoration. A paradigm shift from osseointegration to a more holistic assessment of implant success has placed an emphasis on biologically driven treatment approaches, accentuating optimal tissue regeneration, esthetic outcomes, and long-term peri-implant health.