Revue belge de medecine dentaire最新文献

An early determination of pulpal vitality is crucial with respect to a correct differential diagnosis of revascularisation or necrosis and its treatment. The use of sensibility tests (cold, heat, electrical pulp test) in combination with X-ray are commonly promoted. However these tests are arbitrary, based on sensations and therefore not always reliable. In such situation the registration of 'real' pulpal blood flow and hence pulp vitality will be more than an added value. The most studied and well documented method is laser Doppler flowmetry (LDF) as it is non invasive, direct and objective. In this article we describe blood flow, LDF and its characteristics, advantages and disadvantages of this method and the newest developments regarding LDF. Despite a low implementation of LDF in Belgium, this technique proved to belong indisputable to the basic assets of a dental clinic. A number of cases are described to demonstrate the efficacy and added value of LDF in assessing tooth vitality.

The most important constituent of the bleaching process is the hydrogen peroxyde. The bleaching effect is the result of a change in the chemical structure of organic molecules in the teeth. Different bleaching techniques are described on the basis of the concentration of the hydrogen peroxyde used and on the basis of the different methods of application. It has been demonstrated that a faster change in colour can be obtained when bleaching is performed in combination with a light source i.e. power bleaching aiming for a more in depth change of colour. Different investigations have demonstrated that negative effects associated with bleaching agents are seen earlier when light sources have been used as accelerators. So, light activation may not lead to 'heating of the pulp'. Different types of laser bleaching have been described, though, not all of them will lead to the desired result. There is only one exception at present and this is the KTP-laser bleaching with the Smart Bleach gel. The specific laser-tissue interaction is the result of different activation processes of the hydrogen peroxyde in the gel: as a result of the interaction with the laser a photocatalytic effect is induced (i.e. the activation of the gel by means of light--this is also referred to as a photochemical reaction), a limited photothermal effect (light absorption may result in a certain heating of the gel). The light activated gel also has an alkaline pH, which favours the ionisation of the hydrogen peroxyde into perhydroxyl ions (these are the most reactive free radicals). It is also possible to directly cut the tetracycline molecules (a good absorption of light by the tetracycline molecules at 532 nm). This will result in better decolouration of tetracycline stained teeth. This last process is described as direct photobleaching. It also needs to be emphasized that bleaching with a laser can only be performed by a dentist who has acquired a substantial knowledge on laser-tissue interaction and laser physics, and who follows accurately the requested bleaching procedure. Furthermore, whatever the opinion might be, tooth bleaching is a medical dental procedure on biologic tissues and hence this procedure can only by dentists.

The two direct dental restorative materials most commonly used today are silver-mercury amalgam and resin-based composite. The survival of dental amalgam restorations is twice as high than for composite fillings: polymerisation shrinkage, deficient marginal adaptation, higher wear rates, defective contact points leading to food impaction, insufficiently converted composite at the bottom of the cavity are problems that cannot be underestimated when using resin-composite. This does not imply that there is no weakness for amalgam: the need for retentive cavities at the cost of healthy tooth substance, weakening of the tooth's strength by cutting through the tooth crown's ridges, the risk of fracture of remaining tooth substance (mostly buccal and lingual surfaces) as the result of the cavity design, and the lack of adhesion between amalgam and tooth substance. Retaining a tooth's strength by the replacement of amalgam by resin-composites is not always the correct solution. In this respect, it can be questioned whether it is not appropriate to repair failing (extensive) amalgam restorations as to replace them with resin-composites. Research in this respect has demonstrated that dentists still are not convinced of this treatment option. Restoring a tooth in its original build-up or structure and function within the oral cavity is the basis of the biomimetic principle: the use of composite appears to be more obvious than restoring with amalgam. In the present survey pro's and con's of amalgams and resin-composites for the restoration of posterior teeth are weighted. The conclusion demonstrates that there is still a place for dental amalgam in modern restorative dentistry when plastic filling materials are used for the direct tooth repair or restoration.

The importance of maintenance care for controlling periodontitis and preventing disease recurrence is well-documented. Supportive periodontal therapy is essentially based on periodontal risk assessment, oral hygiene reinforcement and professional cleaning. As most of the referred periodontal patients return to the general practitioner at some point, supportive periodontal therapy should be continued in general practice. This manuscript offers the clinician, in particular the general practitioner, a number of guidelines to organize maintenance care.

Non-surgical root debridement is usually the first step in the treatment of chronic periodontitis. This can be performed in one day or in multiple sessions over several weeks using manual instruments and/or power-driven instruments. Besides scaling and root planing, the removal of plaque-retaining factors and mechanical oral hygiene measures are essential for a favourable treatment outcome.

Dental amalgam containing mercury has been condemned because of its toxicity and hence to be damaging of harmful to the general health. It must be clear that many sensational, confusing and misleading reports have been published. Today there is evidence that dental amalgam in the oral cavity does not harm anyone's health. For those who are condemning amalgam there an abundant number of alarming reports taking into consideration the biologic effects of resin composites: methacrylate allergy for dentists and dental technicians, the three-finger-syndrome due to contact with liquid resin, allergic reactions at the level of the airways and breathing problems caused by dust particles (esp. composite particles after polishing procedures) have been described. It can be concluded that dental amalgam is not more toxic than resin composite in light of both patients' and dental care providers' health. Recent investigations demonstrated higher than expected health risks with resin composites.

Proper examination of patients is essential in assessing treatment needs. This includes at least a thorough anamnesis and clinical examination. As periodontal diseases are highly-prevalent in Belgium, every patient should be examined as such on a routine basis in general practice. After all, early detection of pathology avoids extensive periodontal therapy and favours tooth retention in the end, which is the ultimate goal. This manuscript offers the clinician, in particular the general practitioner, a number of guidelines in reference to periodontal diagnosis.

The pigmentation is the physiological or pathological accumulation of a pigment in a tissue. Physiological pigmentation in gingiva which is a part of masticatory mucous membranes depends on the activity of the melanocytes. These non keratinocytic cells include the melanosoma where an endogenous pigment, the melanin, is synthesized. Quantitative or qualitative disruption of mucous pigmentation leads to the apparition of pigmented lesions. When melanocytes are directly concerned, the lesions can be of intrinsic origin, such as oral mucosa melanoma, the nevus, pigmented oral lichen planus etc. Pigmented lesions can be also of extrinsic origin caused by medicaments, dental materials, tobacco etc. In this article, gingival pigmentations are described to allow practitioner to elaborate a differential and positive diagnosis of gingival pigmented lesions and to facilitate an early detection of these lesions particularly the gingival melanoma.

Assessing the quality of dental care depends on the approach. From the patient's perspective the perception of the quality of care depends as much on the pure technical quality of the treatment as on the level of patient - doctor communication, organisation and administration experienced in relation to the treatment. From the point of view of the dental professionals who tend to focus primarily on outcome of treatment on the other hand, this way of patient's judging integrated quality of care might be quite frustrating. After all, thanks to verbal and organisational skills, making good impression despite bad diagnostic and treatment quality might come within reach of simply every dental professional. As desirable it might be, is it possible anyhow to measure if the ultimate quality of care meets the standards of care patients deserve? Certifying outcome of treatment is difficult since it depends on too much variables amongst which some (such as patient's compliance) might fall out of reach of control of the dental care professionals. That's why modern clinical guidelines and protocols stress on creating the ideal treatment steps and conditions most likely leading to the most favourable treatment result. Finally authorities and policymakers aspire more and more to the idea of indicators measuring clinical quality of care from a cost effectiveness point of view. In this respect the authors state that cheap high quality dental care for everybody has become out of date in the actual context. And defining limits to quality of care in order to gain affordability or accessibility, is going to be a tricky exercise requiring sound scientific thinking balanced with ethics.