Special-needs Patients Research Articles

Dental treatments in patients with special needs provided by university medical center in Southern Taiwan: a retrospective study.

We perform special-need dental treatment at outpatient department (OPD), under general anesthesia (GA) when necessary, and provide domiciliary dental care. We aim to evaluate the profile and the characteristics of special needs patients (SNPs). We consecutively enrolled 3117 SNPs from January 1, 2019 to December 31, 2022. Eighty patients with rare or genetic diseases were excluded. Demographic data were retrospectively collected. There were totally 3037 SNPs (mean age: 48.2 years; range, 1-100; male-to-female ratio, 1.5); 89.1% (n = 2705) SNPs received dental care at the OPD (OPD-SNPs), 7.9% (n = 239) received dental treatment under GA, and 3.0% (n = 93) received domiciliary dental care. Among those SNPs who received dental treatment under GA (n = 239), 91.2% (n = 218) were mental/intellectual disabled, and most underwent cavity filling (69.5%) and dental extractions (56.5%). OPD-SNPs with mental/intellectual disabilities (n = 1340) received significantly more items of dental treatment than those without (n = 1365). SNPs with more severe disabilities received more fluoride application and ultrasonic scaling (both p < 0.001, trend tests). Interestingly, among OPD-SNPs with mental/intellectual disabilities (n = 1340), more severe patients received more fluoride application (p < 0.001) and ultrasonic scaling (p < 0.001) but fewer root canal treatment (p = 0.007, trend test). GA benefited SNPs with more dental procedures, including invasive items. SNPs with mental/intellectual disabilities can tolerate more measures and SNPs with more severe mental/intellectual disabilities received more preventive measures but less invasive measures. Similarly, more severe SNPs with other disabilities received more preventive measures but not invasive measures. Our findings may provide useful information for special needs dentists and for doctor-patient communication.

Perception of Special-Care Dentistry among Dental Students at Universitas Indonesia: A Cross-Sectional Study.

To assess the perceptions of special-care dentistry (SCD) among dental students in the Faculty of Dentistry, Universitas Indonesia, Indonesia. This cross-sectional study used a self-administered online questionnaire, and all preclinical and clinical students were invited to participate. The survey items comprised four domains related to participants' characteristics, perceptions of SCD, perceptions of managing patients with special needs, and perceptions of SCD education. The chi-square test and Mann-Whitney test were used in the analysis. A total of 572 students participated in this study. The findings showed that the clinical students were more familiar with SCD than the preclinical students were (p = 0.008). A statistically significant relationship was found between the study program and the ability to work independently with special-needs patients after graduation (p < 0.001), the ability to refer special-needs patients to specialists (p = 0.042), the perception of postgraduate training-program needs (p < 0.001), and the opportunity to consider postgraduate training (p = 0.004). Most of the respondents had a favorable perception of SCD. Thus, an improved SCD curriculum and SCD training for undergraduate and postgraduate students should be provided to develop the knowledge and skills needed to provide care to special-needs patients.

Dental Treatment in Special Needs Patients and Uncooperative Young Children: A Retrospective Study.

Background and Objectives: Special Needs Patients (SNPs) and young non-collaborative children are more predisposed to develop oral pathologies due to poor collaboration and scarce access to dental treatment. The aim of this retrospective study was to analyze a sample of SNPs who received dental treatments either under general anesthesia (GA) or deep sedation (DS) over a period of 6 years. The number and type of procedure were analyzed. Materials and Methods: In total, 131 patients were included and mostly (>90%) treated under GA. Patients were either uncooperative and phobic (Group 1) or affected by mental, behavioral, and neurological disorders (Group 2), diseases of the nervous system (Group 3), or developmental anomalies (Group 4). Results: Patients in Group 2 required more invasive dental treatments than those in the other groups. Therapies were mainly preventive and restorative, except in Groups 3 and 4, where extractions were more frequent. The type of dental treatment significantly varied according to age and systemic condition. Only 5.3% of the patients needed a second intervention, despite only 17.6% of patients respecting the scheduled follow-up. Conclusions: Treatment under GA is effective, but the poor adherence to follow-ups and the risk of reintervention should be contrasted by improving the perception by parents/guardians of the importance of oral hygiene and periodic visits.

Challenges in providing special care dentistry during COVID-19 pandemic: a survey of public dental care services in Italy.

The aim of this paper was to assess COVID-19 pandemic impact over the public health care services (HCS) involved in special care dentistry (SCD). Customized questionnaire was sent to 45 HCS involved in SCD. Healthcare personnel (HP) on duty, safety of HCS, time of suspension and reduction of routine dental practice in special needs patients (SNP), kind of SNP mostly penalized during pre-COVID period/T1, lockdown (phase 1/T2) and post pandemic reopening (phase 2/T3) were analyzed by statistical means (P<0.05). 21 questionnaires were returned. A significant decrease of median number of HP during T2 was observed. Prevalence of COVID-19 infection among HP was not significantly different between T2 vs. T3. Medical surveillance of HP during T2 was significantly lower than during T3. Patients with lack of cooperation were the most disadvantaged during both phases dental procedures were significantly lower between T1 and T2 and between T1 and T3 as well. Patients with lack of cooperation and/or living in residential care homes were the most disadvantaged in relation to access to dental care during both phases. COVID-19 pandemic determined significant restrictions in daily access to routine oral care resulting in reduction of preventive evaluations and decline of oral health in a population which is already at a higher risk of oral pathologies. Our data reveal that reduction of dental procedures, healthcare professionals and days of suspension of clinical activity were still considerable also in T3 with respect to T1 and in some cases not significantly different from T2.

Long-term outcome of oral health in uncooperative children with caries treated under general anesthesia.

Although uncooperative children with extensive caries can be treated under general anesthesia (GA), they remain at high-risk for caries recurrence. This study aimed to assess the long-term outcome of the dental health of uncooperative healthy children (HC) and special needs patients (SNP) treated under GA at least 2 years before this study. Data were collected via questionnaire and oral examination. Oral hygiene was assessed using the Hygiene Index, while caries were recorded using ICDAS II. The dmfs/DMFS score was calculated for every participant. A total of 69 patients completed the questionnaire, and 37 were clinically examined (HC = 15, SNP = 22). The mean (±SD-standard diviation) follow-up time was 5.5 (±2.55) years, the mean DMFS score for HC was 6.39 (±4.99), and the mean DMFS score for SNP was 12.95 (±12.29). The SNP group had significantly more filled surfaces on permanent teeth than the HC group (6.18 (±6.17) vs. 1.54 (±3.27), p = 0.004). In regard to primary teeth, HC had a higher dmfs, indicating a clear trend for more decayed surfaces in this group of participants (p = 0.08). The DMFS score was significantly higher in children who underwent GA more than 5 years ago. Oral health-related behavior was not improved as expected. Altogether, HC and SNP have poor oral hygiene and high caries risk in primary and permanent dentition, and their treatment remains challenging.

Oral Health-Related Quality of Life Improvement in Children with Special Needs Following Comprehensive Dental Treatment under GA: A Saudi-Based Follow-up Study

Introduction: Children with Special Healthcare Needs (CSHCN) are considered difficult to maintain oral hygiene and challenging for caregivers and dentists to attain cooperation in dental treatment under general anaesthesia. Family Impact Scale (FIS) and Parental-Caregiver Perceptions Questionnaire (P-CPQ) are useful tools to assess patient’s oral health quality of life and caregivers perception. Aim: To assess the impact of dental treatment under general anaesthesia on the quality of life and oral hygiene of CSHCNs, as perceived by caregivers. Materials and Methods: This prospective follow-up survey study was carried out at Dammam Medical Complex, Saudi Arabia, from December 5th, 2019 to December 15th, 2021. The CSHCN of either gender, aged 12 years, and falling within the American Academy of Pediatric Dentistry (AAPD) definition of special-needs patients referred for invasive procedures under general anaesthesia (American Society of Anaesthesiologists (ASA) class I or II), were included. The baseline and, after a one-year follow-up, information obtained from two surveys that were altered from Thompson’s P-CPQ and FIS were decoded into the numeric ordinal scales Never (“0”), Once or Twice (“1”), Sometime (“2”), Always (“3”), and Daily (“4”). Analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 84 participants were caregivers of CSHCN who underwent dental procedures under General Anaesthesia (GA), of whom 77 (91.7%) were mothers and 7 (8.3%) were fathers of the CSHCN. The mean age of children was 8.29±2.14 years (Range= 3-12 years); 38 (45.2%) were males and 46 (54.8%) were females. The median FIS after treatment was zero, compared to the median before treatment which was 2, revealing a significant impact on being absent from work, a child requiring more care, the impact of presence, sleeping disturbances, feeling angry, feeling guilty, and a child disputing or blaming either parent (p&lt;0.001). Following the pattern of one year post-treatment FIS, median was 0 (Never) for all items including halitosis, pain, food trapped in palate and teeth, swallow, breath, time, sleep, irritable, frustrating, nervous, shy, absent, laugh, and continue school (p&lt;0.001). Conclusion: The modified FIS and P-CPQ evaluations before and after dental treatment under GA revealed a significant improvement in the oral health quality of life for those CSHCN, as well as the impact on their caregivers. Regular check-ups would be useful for early and non invasive intervention without GA.

Powered Toothbrushes: An Opportunity for Biofilm and Gingival Inflammation Control.

The present review aimed at a broad investigation on the potential of powered as compared to manual toothbrushes in different aspects of clinical dentistry. Studies evaluating plaque and gingival inflammatory parameters were included, as well as those that investigated adverse effects. Emphasis was given separately to adults, youngsters, special-needs patients, and those under fixed orthodontic therapy. In general, comparisons favored powered toothbrushes. In summary, approximately 68% of the included studies, in terms of plaque/gingival inflammation in adults, presented better results for powered toothbrushes. In children and special-needs populations, approximately 40% of the included studies favored powered toothbrushes for plaque/gingival inflammation, and none favored manual ones. In orthodontic individuals, 50% of the studies also demonstrated a better effect of powered toothbrushes on plaque and gingival inflammation. All included studies that assessed adverse events did not demonstrate a difference in these effects when comparing manual vs. powered toothbrushes. It is concluded that the use of powered toothbrushes is an opportunity to enhance patterns of plaque control and associated gingival inflammation.

Dental Treatment for Special Needs Patients Under General Anaesthesia: A 14-year Experience from South Bosnia and Herzegovina.

We conducted a retrospective analysis of records of special needs patients (SNPs) who received dental treatment under orotracheal-intubation general anaesthesia (OIGA) at Caritas Centre St. Family in Mostar, Bosnia and Herzegovina during the 14-year period from January 2005 to December 2018. Of the 7,085 SNPs who received dental treatment, 1,220 (17.2%) received dental treatment under OIGA: 829 (67.9%) males and 391 (32.1%) females. The patients' mean age was 18.3±10.9 years (747 paediatric and 473 adult patients). Mental retardation and psychiatric problems were the most common medical conditions (81.22%). The most common indication for dental treatment under OIGA was behaviour management (87.21%), and 81% of the patients had an urgent need for treatment. Many of the patients had restorative treatment (3,833) and tooth extractions (3,681). From 2011 onwards, the number of tooth extractions decreased significantly. Annual trends revealed a rapid increase of patients every year. The mean dental treatment duration was 95.3±12.1 min; the mean time under OIGA was 98±8.5 min. No serious adverse effects occurred. There was increase of annual trend of SNP in OIGA. The number of extractions decreased while the number of preventive and restorative dental treatments increased.

ZeroExpander: Metal-free automatic palatal expansion for special-needs patients.

The aim of this paper is to illustrate a new concept for approaching maxillary expansion in paediatric orthodontics with a metal-free fixed automatic appliance in special-needs patients. The ZeroExpander is a complete CAD-CAT full digital and automatic metal-free fixed device. It is designed to expand the maxilla in a pre-programmed automatic way using deciduous teeth as anchorage. Two cases of growing patients with a narrow upper arch are illustrated to present this innovative system, one in complete deciduous dentition and the second in mixed dentition. Both patients were successfully treated with palatal expansion. In the first case we present the use of PEEK, and in the second one the use of PA12. The ZeroExpander, fabricated using metal-free technopolymers and anchored on deciduous teeth, proved to be comfortable and efficient in treating palatal transverse deficiency, without the need of any compliance, even in young patients who must periodically undergo MRI.

Knowledge, Attitude and Behavior of Dentists Toward Management of Special Needs Patients in Benghazi City

Background: Special needs patients (SNPs) are one of the underserved dental patient worldwide. A compromised oral health condition amongst SNPs has been associated with shortage of skills of dental professionals in management. Objective: to determine the level of knowledge, attitudes and behaviors of Libyan dentists towards caring for SNPs. Methods: A cross sectional study including Libyan dentist in public and private dental clinics in Benghazi. Data were collected from a representative sample by using a modified questionnaire. Results: In the total sample (234), 32.1% of participants were males and 67.9% were females. More than half of them lacking knowledge about dealing with severely mentally disabled patient while more than 63% of dentists know major barriers in treating SNPs and more than 66% of respondent consider lecture as main source of their knowledge about special care dentistry.&#x0D; Most of them do not believe that all mental disabled patients need sedation before treatment, majority of respondent believe that the communication between dentist and special needs patients will be effective in treatment, and most of dentists did not feel confident in providing care for them. 90.2% of respondent use non-pharmacological method of behavior control rather than sedation and general anesthesia .Around 90% of participants cannot manage mentally disable patients in their clinics with around 70% did not have the facilities for treating SNPs at their dental clinics.&#x0D; Conclusion: Dentists were lacking knowledge about dealing with severe mentally disabled patients, meanwhile they had a good knowledge regarding major barriers in treating SNPs. They had a positive attitude that they believe not all mental disabled patients need sedation before treatment and the communication between dentist and special needs patient will be effective in treatment while they had a negative attitude that they did not feel confident in providing care for them, they cannot manage mentally disable patients in their clinics. There is a good issues that dentists use of non-pharmacological methods to prepare them for dental visits.

Percepção e atitudes dos cirurgiões-dentistas de Unidades Básicas de Saúde sobre o atendimento de Pacientes com Necessidades Especiais

O atendimento a pacientes com necessidades especiais (PNE) na Odontologia exige uma abordagem diferenciada. São relatadas dificuldades desta população em conseguir atendimento, principalmente no serviço público. O objetivo deste estudo foi investigar a percepção e as atitudes dos cirurgiões-dentistas (CD) da rede municipal de saúde de Pelotas/RS no atendimento a PNE. Participaram 47 profissionais de Unidades Básicas de Saúde que responderam a um questionário sobre rotina profissional, tempo de formado, qualificação profissional, experiência, atitudes e dificuldades no atendimento de PNE. Foi realizada análise descritiva e o Teste Exato de Fisher para avaliar associação entre as características do CD, sua percepção, experiências e atitudes frente ao atendimento. A maioria (93,6%) dos CDs relatou atender PNE e a dificuldade mais relatada foi a falta de auxiliar (58,5%). Houve uma melhor percepção em relação ao atendimento ao PNE ente aqueles CD que fazem parte da equipe da Estratégia Saúde da Família, com menos tempo de formado e que se dedicam integralmente ao setor público. Conclui-se que, apesar da maioria dos CD relatarem prestar atendimento odontológico ao PNE, diversas dificuldades foram apontadas, sendo a principal a falta de auxiliar.

Special-Needs Patients in Pediatric Dentistry: Progeroid Syndrome. A Case of Dental Management and Oral Rehabilitation

This report presents a case of an eightyear- old girl affected by a progeroid syndrome of unclear genetic origins. The patient’s dental history included oligodontia, premature deciduous exfoliation and roots abnormalities. She was treated with comprehensive oral rehabilitation using dentures. Oral health instructions were given during the whole treatment and follow- up period. The goal of improving the masticatory function and the esthetic was achieved, allowing the patient to increase her social abilities and self-confidence.

Prevalence of dental trauma in disabled persons seen at the dental clinic for special-needs patients of the Catholic University of Brasília (UCB)

Abstract Introduction In Brazil, dental trauma (DT) is considered a public health problem. However, few studies in the literature report the prevalence of DT in disabled persons (DP). Objective The aim of this study was to assess the prevalence of DT among DP seen at the Dental Clinic for Special-Needs Patients (COPE) of the Catholic University of Brasília. Material and method A retrospective, descriptive study analyzing 73 medical charts of DP seen at the COPE between 2014 and 2016 was conducted. Clinical and sociodemographic data were collected. The t-test was used to check for significant differences between the categories of the variables analyzed. The Statistical Package for Social Sciences (SPSS), version 23.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses (p &lt; 0.05). Result A DT prevalence of 33/73 (45.2%) was found among DP. The predominant type of fracture was crown fracture (26/33-78.8%). The majority of patients were over 20 years old (63/73 - 86.3%), at a proportion significantly higher than those for the other age categories (p &lt; 0.008). The patients in the sample had a variety of diseases, predominantly in the following categories: mental (22/73- 30.1%), multiple (19/73-26%), and systemic (14/73-19.2%). Conclusion A high prevalence of DT was found in DP, with the majority of cases being related to mental and multiple diseases. Further research is needed to assess the prevalence of DT in this patient group throughout the Federal District.

A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period.

The purpose of this study was to perform a comprehensive audit of dental treatment provided to special needs patients (SNP) under general anesthesia (GA) over a ten-year period. Special needs patients who received dental treatment under GA as an in-patient at Queen Mary Hospital, Hong Kong SAR during the time period January 2002 and December 2011 were included in the study. The study population was divided into three groups, based on age (<6years, 6-12 years, >12 years). One-way ANOVA was used to evaluate the effect of "age group" on duration of treatment, post-recovery time, treatment procedures and utilization of different restorative materials. Kappa statistics were used for intra-examiner reliability. A total of 275 patients (174 males and 101 females) were included in the study. The mean age of the patients at the time they received GA was 12.37±10.18 years. Dental procedures performed were mostly restorative in nature (47%). The >12 years group had significantly shorter treatment duration (p<0.05). No significant difference in post-operative recovery time was observed among the three age groups (p>0.05). The <6 years group received significantly less preventive, but more restorative procedures (p<0.05). Significantly fewer extractions were performed in the 6-12 years group (p<0.05). The use of composite restorations was significantly higher in the <6 years group; while amalgam restorations were more frequently used in the >12 years group (P<0.05). Stainless steel crowns were more frequently employed in SNP under 12 years of age (p<0.05). Intra-examiner reliability was good (k=0.94). Most of the dental procedures performed under GA on SNP were restorative procedures. For children less than 6 years of age, had longer treatment time under GA. Composite restorations and stainless steel crowns were more frequently used in the primary dentition and amalgam restorations were more frequently employed in the permanent dentition.

Behavior Guidance Techniques used in Dental Care for Patients with Special Needs: Acceptance of Parents

Objective : To evaluate the acceptance of the parents of special needs patients (SNP) concerning behavior guidance techniques (BGT) used for the dental care. Methods : Participants were asked to answer a sociodemographic questionnaire and, after this, they received individual explanations regarding each of the BGT, and answered if they accepted, accepted with restrictions or did not accept each one of them. Data were analyzed using binomial nonparametric test for the difference between proportions and the chi-square test. Results : Participated 83 parents of SNP. All of them considered the use of communicative management (CM) for the patients’ dental care to be totally acceptable. The use of protective stabilization (PS) was considered acceptable by 76 parents (91.57%), sedation (SD) by 65 parents (78.32%), general anesthesia (GA) by 63 parents (75.90%) and nitrous oxide inhalation (NOI) by 62 parents (74.70%). The differences between the levels of acceptance for each method regarding the three educational levels were not statistically significant. Sedation was statistically more readily accepted by parents of patients aged 31 to 40 years when compared with those of children until ten years of age. The acceptance of protective stabilization was statistically higher for patients with physical disabilities when compared with those of patients who had congenital disabilities, intelligence or behavioral deviations. Conclusion : Communicative management and protective stabilization were statistically more acceptable by parents than the other techniques.

Effective Fluoride Mouthwash Delivery Methods as an Alternative to Rinsing.

Special-needs patients with high caries risk cannot benefit from the proven caries-reducing effect of fluoride mouthrinse because of poor rinsing compliance and a lack of home-use fluoride application recommendations. This study aimed to evaluate whether two modified delivery methods-spray or swab application-could raise the salivary fluoride to levels similar to that of rinsing. Five healthy men and 16 healthy women, ages 18-22 years, participated in this crossover study. The subjects performed a standardized brushing routine twice a day with 1,000-ppm fluoride dentifrice 1 week before and during the experimental period. The three fluoride mouthwash (0.05% NaF; 226-ppm fluoride) administration methods consisted of rinsing, spray, and cotton swab application. Each application was separated by at least 1 week. Unstimulated whole saliva was sampled for 2 minutes at baseline and at 0, 5, 10, 20, 30, 60, and 120 minutes after each fluoride mouthwash application. Salivary fluoride level (ppm) was measured by a blinded investigator using an ion-specific electrode (ORION EA940). The differences in salivary fluoride concentration for each application method were analyzed by repeated measures ANOVA at a nominal significance level of .05. The newly designed fluoride mouthwash delivery methods yielded a similar fluoride level in whole saliva compared to that of rinsing at all time points (p > .05). The t half-life of fluoride concentration ranged from 1.62 minutes (SD = 0.53) in the spray group to 2.08 minutes (SD = 0.87) in the cotton swab group; the values were not significantly different. Our results indicate that the spray and cotton swab fluoride delivery methods were effective alternatives to conventional mouth rinsing. Caregivers of individuals with acute and chronic illness, including developmental disabilities affecting cognitive or physical abilities, may consider using these alternative fluoride delivery methods to help promote dental hygiene.

Special Care Dentistry Curriculum at The Undergraduate Level : Students’ Prespective

Special needs patients (SNP) have difficulty accessing dental services, partly due to reluctance of dentists to treat them. Objective : We assess didactic and clinical training experiences of final-year dental students and new graduates in managing SNP. Methods: An online questionnaire was sent to 123 final year dental students and new graduates, assessing their experiences and readiness in handling SNP. Results: Majority of the respondents were not confident in attending to SNP. Majority gained knowledge in handling SNP via lectures while more than half had managed patients with complex medical history. Majority mentioned a lack of clinical training to treat SNP as their dental training experience had only been in a dental school clinical setting. Most of the respondents hope their curriculum would include more education to improve clinical skills in managing SNP. Conclusion: Respondents demonstrated minimum training and lack of confidence and skills that might contribute to a lack of preparedness to manage the oral health care needs of SNP. Clinical exposure in managing SNP at the undergraduate level is still inadequate and it needs to be emphasized in the curriculum. DOI: 10.14693/jdi.v22i3.976

Dental treatment under general anesthesia for special-needs patients: analysis of the literature.

The aim of the present review was to identify the studies published on dental treatment under general anesthesia for special-needs patients. A comprehensive search of the reported literature from January 1966 to May 2012 was conducted using PubMed, Medline, and Embase. Keywords used in the search were "dental treatment under general anesthesia", "special-needs patients", "medically-compromised patients", and "children", in various combinations. Studies published only on dental treatment under general anesthesia and in English were included. Only 10 studies were available for final analysis. Age range from 1 to 50years, and restorative procedures, were most prevalent. Only two studies discussed repeated general anesthesia, with rates of 7.2% and 10.2%. Over time, the provision of general anesthesia for special-needs patients has changed from dental clinics to general hospitals. The demand for dental treatment for special-needs patients under general anesthesia continues to increase. Currently, there are no certain accepted protocols for the provision of dental treatment under general anesthesia.

A retrospective review of outcomes of dental treatment performed for special needs patients under general anaesthesia: 2-year follow-up.

Objective. The purpose of the study was to evaluate the follow-up pattern of special needs patients (SNP) treated under general anaesthesia (GA) and the failure rates of different treatment procedures and restorative materials. Study Design. The treatment records of the patients who received dental treatment under GA during 2005 to 2009 were reviewed. The duration of follow-up periods, the outcomes of different treatment procedures, and the quality of different restorative materials were recorded and evaluated. Statistics were used for the comparison (SPSS 20.0). Pearson's chi-square test and post hoc analysis were used to evaluate the attendance of postoperative appointments and the associations of failure rates of different treatment procedures and restorative materials. Cohen kappa statistics was used for intraexaminer reliability. Results. A total of 177 patients were included in the study. The attendance of postoperative appointments showed a gradual decrease from 96% to 36% within 24 months (P < 0.05). Restorative procedures had the highest failure rates among all treatment procedures (P < 0.05). Stainless steel crowns showed higher survival rates among different restorative materials (P < 0.05). Pulp treatment in primary molars has higher success rate than primary incisors and canines. Composite restorations placed in primary canines have low survival rates. The intraexaminer reliability was good (k = 0.94). Conclusion. The attendance for postoperative follow-up appointments declined within two years. Restorative treatment was less successful when compared to preventive and pulp treatments. Stainless steel crowns were more reliable restorations with higher survival rates and composite restorations were less durable.

As If He Were Family

We were at the end of our visit, and Ms L didn�t know what to do. About two weeks prior, after having been unemployed for months, Ms L�a relatively healthy, long-standing patient of mine in her mid-40s�had started a job as a bus driver for special-needs patients. She wasn�t used to driving all day every day, especially in stop-and-go traffic, and so it didn�t take long for her sciatica to flare. At first she had excruciating pain in her right lower back radiating into her right leg and no other symptoms. When her right foot began to feel like it was always asleep, which she�d never experienced with her previous sciatic episodes, she became concerned and decided to come in and see me, her primary care physician.