Routine Dental Treatment Research Articles

Medication-related osteonecrosis of the jaw: a preliminary retrospective study of 130 patients with multiple myeloma

BackgroundMultiple myeloma (MM) is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Bisphosphonates (BP) are used as supportive therapy in the management of MM. This study aimed to analyze the incidence, risk factors, and clinical outcomes of medication-related necrosis of the jaw (MRONJ) in MM patients.MethodsOne hundred thirty MM patients who had previous dental evaluations were retrospectively reviewed. Based on several findings, we applied the staging and treatment strategies on MRONJ. We analyzed gender, age, type of BP, incidence, and local etiological factors and assessed the relationship between these factors and the clinical findings at the first oral examination.ResultsMRONJ was found in nine male patients (6.9%). The mean patient age was 62.2 years. The median BP administration time was 19 months. Seven patients were treated with a combination of IV zoledronate and pamidronate, and two patients received single-agent therapy. The lesions were predominantly located in the mandible (n = 8), and the most common predisposing dental factor was a history of prior extraction (n = 6). Half of the MRONJ were related to diseases found on the initial dental screen. Patients with MRONJ were treated with infection control and antibiotic therapy. When comparing between the MRONJ stage and each factor (sign, location, etiologic factor, BP type, treatment, and outcome), there were no significant differences between stages, except for between the stage and sign (with or without purulence).ConclusionsFor prevention of MRONJ, we recommend routine dental examinations and treatment prior to starting BP therapy.

Molecular, cellular and behavioral changes associated with pathological pain signaling occur after dental pulp injury.

Persistent pain can occur after routine dental treatments in which the dental pulp is injured. To better understand pain chronicity after pulp injury, we assessed whether dental pulp injury in mice causes changes to the sensory nervous system associated with pathological pain. In some experiments, we compared findings after dental pulp injury to a model of orofacial neuropathic pain, in which the mental nerve is injured. After unilateral dental pulp injury, we observed increased expression of activating transcription factor 3 (ATF3) and neuropeptide Y (NPY) mRNA and decreased tachykinin precursor 1 gene expression, in the ipsilateral trigeminal ganglion. We also observed an ipsilateral increase in the number of trigeminal neurons expressing immunoreactivity for ATF3, a decrease in substance P (SP) immunoreactive cells, and no change in the number of cells labeled with IB4. Mice with dental pulp injury transiently exhibit hindpaw mechanical allodynia, out to 12 days, while mice with mental nerve injury have persistent hindpaw allodynia. Mice with dental pulp injury increased spontaneous consumption of a sucrose solution for 17 days while mental nerve injury mice did not. Finally, after dental pulp injury, an increase in expression of the glial markers Iba1 and glial fibrillary acidic protein occurs in the transition zone between nucleus caudalis and interpolaris, ipsilateral to the injury. Collectively these studies suggest that dental pulp injury is associated with significant neuroplasticity that could contribute to persistent pain after of dental pulp injury.

Chewing side preference - Impact on facial symmetry, dentition and temporomandibular joint and its correlation with handedness

Introduction: Habitual unilateral chewing develops subconsciously and serves as an example for lateral preference. This study aims to assess the possible impact of chewing side preference to facial asymmetry, temporomandibular joint (TMJ) and oral hygiene and existence of any link between the preferred chewing side (PCS) and handedness. Materials and Methods: A 2-month cross-sectional (observational) study was performed on 76 healthy dentate subjects [24 males (31.6%) and 52 females (68.4%)] with a mean age of 20.8 ± 1.5 years who participated in this study according to the selection criteria. Results: A total of 75 subjects out of 76 (98.6%) were observed to have a PCS. Out of them, 38 chewed on their right and 37 on the left side. Of the 74 right-handed subjects, 48.6% chewed on the right, 50% on the left and 1.4% chewed equally on both the sides. Conclusion: Chewing side preference has a detrimental effect on the TMJ of the corresponding side and is also related to lateral facial asymmetry, which suggests that examination and recording of chewing side preference merit consideration in routine dental examination and treatment planning.

Child abuse reporting: Role of dentist in India – A review

Healthy, protected, educated and well developed child population who will grow up to be productive citizens of the country are pillars of the nation. However, they are dependent on their parents or care givers, which makes them vulnerable to abuse. The primary responsibility of protecting children from abuse and neglect lies with the families or the primary caregivers. However, communities and civil society and all other stakeholders are also responsible for the care and protection of children. The injuries of child abuse may be different for different children, however, several types of injuries are characteristic to abuse. Many of these injuries are easily observed by the dental professional in the course of routine dental treatment and are within the scope of dentistry for identification. This literature review shows that there are very few attempts made to report child abuse from dental offices in India whereas it is mandatory to report child abuse in many other parts of the world. This difference could be attributed to laws regarding this matter and lack of awareness and knowledge of the procedures to be followed. The objective of this paper is to review briefly the role of dentist in identifying child abuse and the norms about reporting it in our country.

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

IntroductionPain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children.Study designIn this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21.ResultsThe area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth.ConclusionAccording to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars’ buccal mucosa is not anesthetized.How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372.

General health and oral health status in elderly dental patients in Isparta, Turkey.

The aim of this study was to describe the oral health, general health status and medication use of elderly dental patients 709 voluntary patients, aged 60 years and over, who attended Suleyman Demirel University Faculty of Dentistry for routine dental treatment between March 2008 and April 2009 in Isparta, Turkey, were interviewed for demographic data, systemic diseases, and lists of medications. The majority of the patients (84.4%) had poor oral hygiene according to the Oral Hygiene Index (OHI). The mean level of the study population's decayed, missing, and filled teeth (DMFT) index score was 19.1 ± 7.3. The prevalence of systemic diseases was high (90%). Women were affected by a significantly higher incidence of systemic diseases than men (96.4% vs. 84.3%; P < 0.001). The percentage of the elderly taking medication regularly was 72.6%. Drug adverse effects were determined in 25.5% of the study population, with more adverse effects observed in women (53.3%) than men (46.7%) (P < 0.001).Dentists must be aware of the dental implications that may arise from systemic diseases and medications and should properly modify elderly patients' treatment accordingly.

Which oropharyngeal factors are significant risk factors for obstructive sleep apnea? An age-matched study and dentist perspectives.

ObjectiveObstructive sleep apnea (OSA) is a common sleep breathing disorder. Untreated OSA may lead to a number of cardiovascular complications. Dentists may play an important role in OSA detection by conducting careful oral examinations. This study focused on the correlation of oral anatomical features in Thai patients who presented with OSA.MethodsWe conducted a prospective comparative study at a sleep/hypertension clinic and a dental clinic at Khon Kaen University in Thailand. Patients with OSA were enrolled in the study, along with age-matched patients with non-OSA (controls). Baseline characteristics, clinical data, and oropharyngeal data of all patients were compared between the two groups. Oropharyngeal measurements included tongue size, torus mandibularis, Mallampati classification, palatal space, and lateral pharyngeal wall area. Multivariate logistic regression analysis was used to identify the factors associated with OSA.ResultsDuring the study period, there were 156 patients who met the study criteria; 78 were patients with OSA and the other 78 were healthy control subjects. In the OSA group, there were 43 males with a mean age of 53 (standard deviation 12.29) years and a mean BMI of 30.86 kg/mm2. There were 37 males in the control group with a mean age of 50 (standard deviation 12.04) years and a mean BMI of 24.03 kg/mm2. According to multivariate logistic analysis, three factors were perfectly associated with OSA, including torus mandibularis class 6, narrow lateral pharyngeal wall, and Mallampati class 4. There were two other significant factors associated with having OSA, namely, BMI and Mallampati classification. The adjusted odds ratios (95% confidence interval) of these two factors were 1.445 (1.017, 2.052) and 5.040 (1.655, 15.358), respectively.ConclusionDentists may play an important role in the detection of OSA in patients with high BMI through careful oropharyngeal examination in routine dental treatment. A large torus mandibularis, Mallampati class 4, and a narrow lateral pharyngeal wall are important anatomical risk factors for OSA.

Non-syndromic multiple unerupted supernumerary teeth : a case report

The exact aetiology of supernumerary teeth is still unknown even though many theories have been proposed to explain their presence. Abnormal reactions to a local traumatic episode, environmental factors or a developmental anomaly, and certain syndromes have been implicated as causative factors. Although a single supernumerary tooth or few teeth have been widely reported in the literature, multiple supernumerary teeth are not a common occurrence. Multiple supernumerary teeth affecting all four quadrants of the jaw is a rare dental anomaly which generally is an accidental finding on routine dental radiography. This article reports the case of non-syndromic multiple supernumerary teeth, affecting all four quadrants in a 23-year-old male, who presented to the Faculty of Dental Sciences, University of Peradeniya for routine dental treatment without any significant medical or dental abnormality. A brief review of the literature on multiple supernumerary teeth is also presented.

A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth.

Periodontal disease of equine cheek teeth is common and may lead to tooth loss if left untreated. Limited information is available comparing the effectiveness of treatment methods. The objective of this study was to retrospectively compare the effectiveness of 4 commonly used treatments in reducing periodontal pocket depth (in addition to routine dental treatment and occlusal equilibration). The 4 treatments compared were (1) removal of feed material, lavaging the pocket with dilute chlorhexidine, and then rinsing the mouth with chlorhexidine-containing mouthwash (CL); (2) CL plus placement of metronidazole into the pocket (M); (3) M plus the addition of polyvinyl siloxane temporary filling over the diastema (PVS); and (4) diastema widening to increase the interdental space, then PVS (DW). Pocket measurements were compared before and 2 to 6 months after treatment. Treatment groups CL, M, and PVS showed statistically significant reductions in pocket depth following treatment. The mean pocket depth reduction was the greatest in the DW group (and this was the only group with no cases having an increase in pocket depth), but this was not significant due to the small sample size. Additional analysis to compare effectiveness revealed a confounding effect of initial pocket depth. After accounting for this, DW was associated with smaller improvements than the other treatments, however, this was also based on a small sample size. After accounting for confounders, differences between treatments CL, M and PVS were not found to be significant, although all were associated with statistically significant reductions in pocket depth.

Integration-Free Reprogramming of Lamina Propria Progenitor Cells

Producing induced pluripotent stem cells (iPSCs) from human tissue for use in personalized medicine strategies or therapeutic testing is at the forefront of medicine. Therefore, identifying a source of cells to reprogram that is easily accessible via a simple noninvasive procedure is of great clinical importance. Reprogramming these cells to iPSCs through nonintegrating methods for genetic manipulation is paramount for regenerative purposes. Here, we demonstrate reprogramming of oral mucosal lamina propria progenitor cells from patients undergoing routine dental treatment. Reprogramming was performed utilizing nonintegrating plasmids containing all 6 pluripotency genes (OCT4, SOX2, KLF4, NANOG, LIN28, and cMYC). Resulting iPSCs lacked genetic integration of the vector genes and had the ability to differentiate down mesoderm, ectoderm, and endoderm lineages, demonstrating pluripotency. In conclusion, oral mucosal lamina propria progenitor cells represent a source of cells that can be obtained with minimal invasion, as they can be taken concurrently with routine treatments. The resulting integration-free iPSCs therefore have great potential for use in personalized medicine strategies.

Child dental patient accompanying person: A cross-sectional study

Objective: To determine the child dental patient accompanying person to the Paediatric Dental Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: This cross-sectional, observational study was conducted among patients attending the Paediatric Dental Clinic of University of Benin Teaching Hospital, Nigeria, between June and November 2014. Data collected include age, gender, ethnicity, socioeconomic status of the patient, accompanying person, period of visit (school calendar period, holiday period, or school public holiday), appointment time (morning or afternoon), and type of dental treatment (emergency visit, routine dental treatment, new patient assessment, and follow-up visit). Results: Data of 385 pediatric dental visits of children aged 0.18-16 years with a mean age of 8.57 ΁ 3.99 years were recorded and analyzed. The majority of the participants were Edo State indigenes, females (56.4%), aged 6-12 years (57.1%), and of high socioeconomic status. The majority (60.8%) of the children were accompanied by their mother. Both parents were the main accompanying person of children aged 0-5 years, nonparents for the indigenous children, and fathers in emergency visits. Conclusion: Data from this study revealed mothers as the dominant child dental patient accompanying person. There existed a statistically significant difference among accompanying person, age of patient, ethnicity, and type of treatment.

Microleakage of Four Dental Cements in Metal Ceramic Restorations With Open Margins.

Background:Fixed prosthodontics is a routine dental treatment and microleakage is a major cause of its failure.Objectives:The aim of this study was to assess the marginal microleakage of four cements in metal ceramic restorations with adapted and open margins.Materials and Methods:Sixty sound human premolars were selected for this experimental study performed in Tehran, Iran and prepared for full-crown restorations. Wax patterns were formed leaving a 300 µm gap on one of the proximal margins. The crowns were cast and the samples were randomly divided into four groups based on the cement used. Copings were cemented using zinc phosphate cement (Fleck), Fuji Plus resin-modified glass ionomer, Panavia F2.0 resin cement, or G-Cem resin cement, according to the manufacturers’ instructions. Samples were immersed in 2% methylene blue solution. After 24 hours, dye penetration was assessed under a stereomicroscope and analyzed using the respective software. Data were analyzed using ANOVA, paired t-tests, and Kruskal-Wallis, Wilcoxon, and Mann-Whitney tests.Results:The least microleakage occurred in the Panavia F2.0 group (closed margin, 0.18 mm; open margin, 0.64 mm) and the maximum was observed in the Fleck group (closed margin, 1.92 mm; open margin, 3.32 mm). The Fleck group displayed significantly more microleakage compared to the Fuji Plus and Panavia F2.0 groups (P < 0.001) in both closed and open margins. In open margins, differences in microleakage between the Fuji Plus and G-Cem as well as between the G-Cem and Panavia F2.0 groups were significant (P < 0.001). In closed margins, only the G-Cem group displayed significantly more microleakage as compared to the Panavia F2.0 group (P < 0.05). Paired t-test results showed significantly more microleakage in open margins compared to closed margins, except in the Fuji Plus group (P = 0.539).Conclusions:Fuji Plus cement exhibited better sealing ability in closed and open margins compared to G-Cem and Fleck cements. When using G-Cem and Fleck cements for full metal ceramic restorations, clinicians should try to minimize marginal gaps in order to reduce restoration failure. In situations where there are doubts about perfect marginal adaptation, the use of Fuji Plus cement may be helpful.

In Vitro Evaluation of ProRoot MTA, Biodentine, and MM-MTA on Human Alveolar Bone Marrow Stem Cells in Terms of Biocompatibility and Mineralization

IntroductionStem cell technology has been a great hope for the regeneration of cells of pulp-dentin complex and dental structures together with surrounding bone and periodontium. The main challenge in the regeneration process is a successful combination of stem cells and efficient inductors such as inductive biomaterials. In this regard, today, manufacturers propose novel tooth filling materials. The current study was aimed to compare the effect of ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK), Biodentine (Septodont, Saint Maur des Fossés, France), and MM-MTA (Micro-Mega, Besançon Cedex, France) on the cell viability, hard tissue deposition capacity, and osteogenic differentiation of human bone marrow stem cells (hBMSCs) derived from mandibular bone. MethodsDental materials were packed into Teflon rings (Grover Corp, Milwaukee, WI) and placed on Transwell inserts (Corning, Corning, NY) to determine the toxicity of tooth filling materials by the 3-(4,5-dimethyl-thiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfo-phenyl)-2H tetrazolium assay on days 1, 3, 7, and 14; 20% dimethyl sulfoxide (DMSO) was used as a positive control for the toxicity assay. hBMSCs were characterized by their surface markers with mesenchymal stem cell antibodies. Teflon rings were cocultured with hBMSCs followed by the induction of osteogenic differentiation. The osteogenic differentiation of hBMSCs and hard tissue formation of the materials were evaluated by analyzing the messenger RNA expression levels of osteonectin, Runt-related transcription factor 2, and collagen type 1A by real-time polymerase chain reaction expression analysis, measurement of alkaline phosphatase activity, and visualization of calcium deposits by alizarin red staining. ResultsMTA, Biodentine, and MM-MTA did not exhibit a cytotoxic effect on hBMSCs after 14 days in culture. Even though all the materials significantly stimulate (P < .05) osteogenic differentiation of hBMSCs compared with the negative control, ProRoot MTA showed greater osteoinductivity than Biodentine or MM-MTA according to the messenger RNA expression, alkaline phosphatase, immunocytochemistry, and alizarin red staining data. ConclusionsAll of the dental materials used in this study show the osteogenic differentiation potential of hBMSCs. Therefore, newly introduced MM-MTA can also be used as a material of choice in routine dental treatment.

Comparison of two epinephrine concentrations in an articaine solution for local anesthesia in children.

Painless dental treatment is of major interest in pediatric dentistry. Local anesthesia contains epinephrine, which prolongs soft tissue anesthesia.This, however, is often a source of iscomfort for children and is responsible for certain side effects (e.g., self-inflicted soft tissue lesions). The aim of this study was to investigate whether an epinephrine-reduced articaine solution could reduce the duration of soft tissue anesthesia and thereby reduce the risk of self-inflicted soft tissue lesions, while still providing an adequate anesthesia. In a non-interventional clinical study, routine dental treatment was performed on children and adolescents. An articaine 4% solution with an epinephrine-reduced solution (Ubistesin™ mite, 1:400,000) and a conventional epinephrine solution (Ubistesin™ forte, 1:100,000) were compared in terms of duration of soft tissue anesthesia. One hundred and fifty-eight patients (mite: 75, forte: 83) were treated (80% with infiltration anesthesia). In both groups, the average volume of the injection was comparable (mite: 1.2 ml, forte: 1.1 ml). One patient from each group showed unwanted side effects. In both groups, the local anesthesia was complete or sufficient (96%) to perform the planned treatment. The average treatment time was 24 minutes in the mite group and 28 minutes in the forte group. The difference in mean duration of soft tissue anesthesia was statistically significant (p = 0.001, mite: 2.1 h, forte: 2.8 h). Thanks to its high efficacy, tolerance, and reduced soft tissue anesthesia, the articaine 4% solution with the reduced epinephrine concentration (1:400,000) was considered a safe and suitable drug for routine treatments in pediatric dentistry.

Adult dental patients with avoidance behaviours.

Dear Editor, Fear is an adoptive human response in the face of danger. This normal and even useful reaction has a protective aspect, while phobia is a pathologic, irrational, and intense fear of a situation or an issue (1). Dental phobia or odontophobia is a pathologic fear that affects about 5% to 15% of adults in the industrialized countries (2). Dental fear is a complex multidimensional phenomenon that its development involves a number of factors including personality traits, fear of pain, previous traumatic experiences (especially in childhood), anxious entourage, and blood-injury fear. Certain variables such as gender and education (socioeconomic status) are associated with anxiety level; therefore, women are more affected than men and the young more than the old. The people with low education and low income are more likely to have higher levels of fear experience (1, 3, 4). Fear is the main obstacle for routine dental treatment. Fear of pain is strongly associated with anxiety and avoidance of treatment that in turn is highly correlated with increased caries morbidity and DMFS scores (5). Kent believes that toothache memory is formed in time and severely anxious patients tend to overestimate their pain (6). Through a vicious cycle dynamic, fear of dental treatment can block normal access to health services, which increases the risk of experiencing oral diseases, and the progressive worsening of untreated oral symptoms can in turn reinforce the fear of dental procedures (4, 7, 8). Since failing to see a physician, gingival problems and tooth decay progress day by day and destruction becomes more severe, the patient has inevitably to recourse and this is just the beginning of the problems. Under such circumstances, the dentist is faced with a situation that is very difficult to treat. In fact, the result of fear and lack of timely treatment is to tolerate more complex, expensive, and time consuming treatments with lower success rate (8). In addition to the above effects, dental anxiety has much greater impacts on quality of life. Cognitive effects include negative thoughts, fear, crying, sleep disturbances, disturbed eating, habits, and greater self-medication (1). Helping highly anxious patients to overcome their fear of dental treatment is a challenge, however if achieved it will result in improvement of their oral health, their overall quality of life, and well-being (1).

Comparison of two epinephrine concentrations in an articaine solution for local anesthesia in children.

Painless dental treatment is of major interest in pediatric dentistry. Local anesthesia contains epinephrine, which prolongs soft tissue anesthesia.This, however, is often a source of iscomfort for children and is responsible for certain side effects (e.g., self-inflicted soft tissue lesions). The aim of this study was to investigate whether an epinephrine-reduced articaine solution could reduce the duration of soft tissue anesthesia and thereby reduce the risk of self-inflicted soft tissue lesions, while still providing an adequate anesthesia. In a non-interventional clinical study, routine dental treatment was performed on children and adolescents. An articaine 4% solution with an epinephrine-reduced solution (Ubistesin™ mite, 1:400,000) and a conventional epinephrine solution (Ubistesin™ forte, 1:100,000) were compared in terms of duration of soft tissue anesthesia. One hundred and fifty-eight patients (mite: 75, forte: 83) were treated (80% with infiltration anesthesia). In both groups, the average volume of the injection was comparable (mite: 1.2 ml, forte: 1.1 ml). One patient from each group showed unwanted side effects. In both groups, the local anesthesia was complete or sufficient (96%) to perform the planned treatment. The average treatment time was 24 minutes in the mite group and 28 minutes in the forte group. The difference in mean duration of soft tissue anesthesia was statistically significant (p = 0.001, mite: 2.1 h, forte: 2.8 h). Thanks to its high efficacy, tolerance, and reduced soft tissue anesthesia, the articaine 4% solution with the reduced epinephrine concentration (1:400,000) was considered a safe and suitable drug for routine treatments in pediatric dentistry.

Intracranial meningioma as a cause of orofacial paraesthesia: a case report

Meningiomas are the most common benign intracranial tumour and show a rising incidence with age. They present with a wide array of symptoms and, in this paper, we discuss a case report of an intracranial meningioma presenting as paraesthesia of the lower left lip and chin region. Coincidentally, the symptoms manifested soon after a course of routine dental treatment, further complicating the diagnosis of the lesion. This case highlights the importance, to clinicians at all levels, of the wide array of causes of nerve paraesthesia within the orofacial region and how less frequently occurring conditions must be considered at an early stage. Clinical Relevance: Intracranial lesions should be included in the differential diagnosis of paraesthesia or anaesthesia of a localized area.

Postoperative pain management

Dental treatment can result in varying degrees of postoperative pain depending on the nature and extent of the treatment, the anatomical site involved and the individual patient’s pain threshold and coping behaviour. Routine dental treatment may result in mild pain while more invasive treatment, such as dentoalveolar surgery, can result in moderate to severe postoperative pain.

Why simple aesthetic dental treatment in general practice does not make all patients happy.

We explored the role of personality and pre-treatment contentment with one's face and body in predicting satisfaction following simple aesthetic dental procedures. In a single-centre repeated measures cohort design we examined the extent to which patient personality and baseline satisfaction with one's face and body predict post-treatment satisfaction. Data were collected from 60 patients attending a UK general practice in 2012. Adults (M age = 60.7 ± 12.6 years) receiving simple, routine aesthetic dental treatment participated. Satisfaction with one's face and body was assessed pre- and post-operatively through validated self-report measures. Although all participants were more satisfied post-treatment with their body overall (t [59] = 2.78, p <0.004) and with their face in particular (t [59] = 1.83, p <0.035), those scoring highly on neuroticism were generally unhappier both before and after treatment (r range = 0.277-0.360, p <0.05). In multiple regressions, post-operative facial satisfaction (R(2) = 0.475, p <0.001) was predicted by pre-operative facial satisfaction (β = 0.616, t = 5.912, p <0.001) and to a lesser extent by neuroticism (β = -0.241, t = 2.248, p <0.001). Baseline happiness with one's body (β = 0.851, t = 11.996, p <0.001) was the sole predictor of post-treatment body satisfaction (R(2) = 0.744, p <0.001). Psychological variables may be important predictors of satisfaction with dental treatment and the clinical benefits of assessing them pre-operatively should be explored.

Comprehensive dental treatment under general anaesthesia

Patients unable to tolerate routine dental treatment in an ordinary dental setting may undergo a wide range of dental procedures under general anaesthesia. This report describes a practical protocol for providing full dental treatment under general anaesthesia. The importance of adequate treatment planning and safety measures is illustrated through the presentation of clinical cases. Suggestions are provided as to the use of techniques managing difficult treatment settings that allow the implementation of high-quality dental care in long sessions. Complete treatment can be achieved in a single visit, thus avoiding repeated risk of anxiety for the patient associated with the treatment as well as subsequent further sessions with related schedule adjustment. I pazienti che non tollerano i trattamenti odontoiatrici di routine secondo le consuete modalità possono essere sottoposti a una vasta gamma di procedure odontoiatriche in anestesia generale. Viene descritto un protocollo pratico per eseguire un trattamento odontoiatrico completo in anestesia generale. L’importanza di un’adeguata pianificazione del trattamento e delle misure di sicurezza viene spiegata attraverso la presentazione di casi clinici. Si forniscono suggerimenti circa le tecniche per la gestione di trattamenti complessi che consentono di attuare cure odontoiatriche di alta qualità in sedute di lunga durata. Le tecniche descritte consentono di eseguire un trattamento completo in una sola seduta, eliminando in tal modo il problema di affrontare più volte l’ansia associata al trattamento stesso e di ricorrere a numerosi appuntamenti con le relative difficoltà di pianificazione.