Revue belge de medecine dentaire最新文献

As the prevalence of periodontitis is more than 40 % in the adult Belgian population, periodontists are clearly understaffed to treat this disease in all patients. Therefore, it seems logic that mild forms of chronic periodontitis are treated by the general practitioner especially because Belgium lacks dental hygienists. Important prerequisites for organizing periodontal care as such relate to the general practitioner who should use the same techniques, have comparable communicative skills to motivate patients and create a similar amount of time for periodontal treatment as the specialist. After all, the patient has the right to qualitative treatment regardless of the level of education of the care provider. In order to guarantee this in general practice as much as possible, there is a need for clinical guidelines developed by specialists. These guidelines should not only support the general practitioner in treating disease; above all, they should assist the dentist in periodontal diagnosis. Hitherto, periodontal screening by general dentists seems to be infrequently performed even though reimbursement of the Dutch Periodontal Screening Index is implemented in the Belgian healthcare security system. In this manuscript possible explanations for this phenomenon are discussed. Apart from the need for guidelines in general practice, guidelines for surgical treatment seem compulsory to uniform treatment protocols in specialized practice. Extreme variation in the recommendation of surgery among Belgian specialists calls for consensus statements.

In many disciplines of medicine guidelines are developed for the diagnosis and treatment of disease. These are essentially intended to standardize care and to optimize communication between the general practitioner and the specialist. Guidelines have already been described in the literature for chronic periodontitis. However, given the unique conditions in Belgium, these may not be appropriate for the average dental practice. In this manuscript the development of Belgian clinical guidelines for the diagnosis and treatment of chronic periodontitis is described. Basically, ten clinical questions were used as a basis for a thorough literature search. Evidence-based clinical guidelines were developed and adapted during three peer review sessions. In the final session Belgian specialists, who had all been invited, participated. This made sure that the scientific input was sufficiently transformed into clinical guidelines which are actually feasible today in Belgium.

The need and development of clinical guidelines for the diagnosis and treatment of chronic periodontitis in Belgium has been previously described. The use of supplementary diagnostic tests in this field is widespread. The question is whether the existing scientific evidence justifies the routine use of these tests in the diagnosis of chronic periodontitis. A thorough search of the literature was conducted in reference to microbiological testing as well as genetic testing for periodontitis.

Recent studies provide evidence that root canal treatment results in excellent clinical outcomes for our patients, which is in favour of the preservation of teeth. Therefore, endodontic treatment remains a highly predictable method to retain teeth with irreversible pulpal disease. Retention rates of root filled teeth of more than 90 percent have been shown. At present there are many alternative treatments available to preserve or replace diseased teeth and considerable progress has been made in this field. With the increasing popularity of implants and for some too complicated the root canal anatomy, more teeth than before are extracted to be replaced with implants. Unfortunately, there has not been that much of research identifying the best strategies for selecting one treatment approach over another. Consequently there is a need for recommendations regarding endodontic versus implant therapy.

The clinician is frequently faced with poor treatment outcome of scaling and root planing predominantly in deep pockets and furcations. In an attempt to optimize clinical effects at these weakly responding sites chemo-mechanical treatment strategies have been developed and studied, among those using chlorhexidine as an antimicrobial agent. In this overview the clinical effects of subgingival chlorhexidine irrigation, gel, chip and varnish administration as an adjunct to scaling and root planing in the treatment of periodontitis are discussed. There is little to no evidence indicating treatment outcome will benefit from subgingival irrigation using chlorhexidine solutions. Furthermore, the use of a chlorhexidine solution as a coolant during (ultra)sonic scaling does not result in a clinically superior response when compared to water cooling. Despite the high viscosity of a gel, its use cannot be justified in the treatment of periodontitis as clinical effects are also negligible. Multi-center studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of scaling and root planing and the administration of a chlorhexidine chip. As some studies failed to confirm this finding, more research is needed to elucidate the additional value of the chip. The subgingival administration of a supersaturated chlorhexidine varnish seems promising as additive clinical effects have been reported. Large-scale studies are however lacking on this treatment concept. The clinician should continue treating periodontitis primarily by mechanical means. Supplemental chemical therapy based on subgingival chlorhexidine administration can be considered; yet, solutions and gels are not suitable as compensatory aids when scaling and root planing becomes less effective.

This paper evaluates the doses delivered to the patient during several radiological procedures in dentistry: intraoral, panoramic and cephalometric radiography. Different digital techniques now available are compared to the AgBr film and film-screen technique. Absorbed doses at different organs are derived from measurements on dental radiological phantoms. The largest dose reductions are observed for intraoral radiography (31-84%). Significant dose reductions are also found for panoramic and cephalometric radiography (25-70% and 30-60%, respectively). By optimizing the exposure parameters and according to the ALARA principle, the smallest doses should be delivered to the patient that are needed to achieve the required quality of the images. Independently on the technique, the beam size should match as closely as possible the size of the detector. Collimation is particularly important for intraoral radiography. The dose at the thyroid should be kept as low as possible especially for children. For some beam incidences, a thyroid shield is especially efficient. The development of digital radiography and the related advantages should not lead to increasing the number of radiographs. The prescribed and performed types of examinations, and their number, should always be selected based on the clinical situation and on sound clinical judgment and experience in order to solve the raised medical problem.

When treated with intravenous bisphosphonates to prevent bone resorption, 4-10% of the patients may develop osteonecrosis of the jaws a side effect. The osteonecrosis is usually preceded by an invasive dental procedure such as the removal of a tooth. Treatment of the osteonecrosis should be conservative using aseptic mouth rinses, oral antibiotics and small debridement. It seems advisable to have a dental check-up before starting using intravenous bisphosphonates, since a potential dental infections can be treated before the bone healing capacity is reduced by the bisphosphonates.

Prolonged and possibly permanent change in sensation due to lingual nerve damage can occur after mandibular block anesthesia. The condition is rare and little can be done to prevent its occurrence. A case report is presented and functional as well as legal implications are discussed. Also practical recommendations are given to help the dentist when faced with the situation.

By computerized subtracting the grey values of geometrically corresponding pixels in consecutively taken digital X-ray images, it is possible to visualize or measure changes in radiodensity over time. This can be very useful, both in clinical and research applications, for the follow-up of tooth mineralization or bone changes. A major problem, however, resides in obtaining a sufficient geometrical standardization of the images. Several techniques have been proposed to this end, most of them still being in development, or too cumbersome to find application in daily routine.

Th. van Nuijs, chief editor of the Revue Belge de Médecine Dentaire, interviews professor Reinhilde Jacobs. R. Jacobs is professor of dento-maxillo-facial radiology and radioprotection at the Catholic University of Leuven. She is also head of the Oral Imaging Centre at the same university.