Effect of enveloping and disinfection methods on artefact formation on enveloped PSP plate images.

OBJECTIVES: To investigate the artefacts caused by different disinfection and protection methods that can be used for infection control of photostimulable phosphor (PSP) plates. METHODS: The plates that were enveloped with single or double envelopes were sprayed with an alcohol-containing solution or wiped with an alcohol-containing tissue. Four PSP groups with two plates in each group were formed (A = wiping single envelope, B = wiping double envelopes, C = spraying onto single envelope, and D = spraying onto double envelopes). Any artefacts (1 = no artefact, 2 = presence of artefact less than 0.5 cm wide, and 3 = presence of artefact larger than 0.5 cm wide) on the 12 acquired images were evaluated. RESULTS: Artefacts (score-3) occurred on the images of Group C-2 PSP plate after the 3rd exposure. According to the Kruskal-Wallis test the difference between the artefact score of the four methods was found significant. Post-hoc comparisons showed the Group C artefact scores were higher than the others and the difference was significant. The total time of enveloping and disinfection processes for groups was; A = 6.30 min, B = 7.58 min, C = 5.48 min, and D = 7.14 min. CONCLUSIONS: Regardless of the number of envelopes, wiping with a tissue was less likely to cause artefacts, while spraying was reliable only when double envelopes were used. However, using a tissue and double envelopes, which are less risky in terms of artefact, causes time loss, difficulty in manipulation, environmental pollution and high cost.

Temporomandibular disorders in patients with inherited coagulation disorders: A clinical study.

INTRODUCTION: One of the most common problems in patients with inherited coagulation disorders, especially hemophilia, is joint problems. This study aims to investigate whether temporomandibular joint (TMJ) is affected in patients with hemophilia or other coagulation factor disorders. MATERIAL & METHODS: In this study, a patient group and a control group were formed. The patient group consisted of 44 individuals with hemophilia or other coagulation disorders (von Willebrand disease and rare factor deficiencies) and the control group consisted of 45 healthy individuals. In both groups, TMJ health was evaluated through a questionnaire and clinical examination. RESULTS: The prevalence of signs and symptoms of temporomandibular disorders (TMD) that we evaluated was higher in the patient group than in the healthy individuals. Pain in the jaw, temple, in the ear or in front of the ear; pain in the jaw, temple, ear or front of the ear by opening the mouth or moving the jaw forward/sideways; closed locking (subjective); jaw joint noises (subjective) and TMJ noises during open & close movements on the right side in clinical examination were statistically significantly higher in the patient group than in the control group. DISCUSSION: There are very limited studies on temporomandibular joint health in patients with coagulation factor deficiency. In this study, it was observed that patients with inherited coagulation disorders, especially hemophilia, were more likely to develop TMD than healthy individuals. This situation was thought to be due to the increased susceptibility to TMJ bleeding in patients with coagulation factor deficiency.

Idiopathic coronal resorption in impacted permanent teeth and its relationship with age: radiologic study.

PURPOSE: The purpose of this study was to evaluate the relationship between idiopathic coronal resorption and age in adult patients. MATERIALS AND METHODS: 3405 digital panoramic radiographs present in the archive of the radiology department belonging to 1584 males and 1821 females aged 25 and over were assessed by two oral and maxillofacial radiologists. The patients' age, gender, number of impacted teeth, number and position of teeth with idiopathic coronal resorption and the extent of coronal resorption were recorded on standard forms. RESULTS: A thousand and nine impacted teeth were observed in 622 patients (304 males and 318 females) with a mean age of 36,92 (±10,85). Idiopathic coronal resorption was present in 26 of the 622 patients with a frequency of 4.2%. One patient had two teeth with idiopathic coronal resorption; resulting in as 27 teeth and a frequency of 2.7% according to tooth number. There were 13 (50%) females and 13 (50%) males having idiopathic coronal resorption. There was no significant difference between genders. The presence of idiopathic coronal resorption increased with advanced age (v: 0,193, p<0.05). There was no statistically significant difference between the extent of the coronal resorption and age. CONCLUSION: The presence of idiopathic coronal resorption increases with advancing age. Idiopathic coronal resorption is detected incidentally during radiographic examination. Thus, dentists should consider this situation and should perform periodically radiographic examination of impacted teeth.

Effects of Angle class II correction with the Forsus fatigue resistant device on mandibular third molars : A retrospective study.

PURPOSE: The goal was to evaluate the effects of Angle class II malocclusion treatment using the Forsus fatigue resistant device (FRD, 3M, St. Paul, MN, USA) on the position and angulation of mandibular third molars and retromolar space. PATIENTS AND METHODS: In all, 58 class II patients (mean age 13.6 ± 1.8 years) treated with the FRD (FRD group) were compared with 51 class I patients (mean age 13.5 ± 1.6 years) who underwent orthodontic treatment (control group). A total of 109 mandibular third molars in the FRD group and 91 in the control group were evaluated. Changes in the retromolar space, angulation of the second (É£) and third molars (ß), and the angle between these teeth (α) were assessed with panoramic radiographs taken at the beginning and the end of the treatment. Data were statistically analyzed. RESULTS: At the end of the treatment, there were significant increases in É£ and ß in the FRD group and É£ in the control group (p < 0.05). The decrease in α in the FRD group and increase in the control group were not significant (p > 0.05); however, this change led to a small significant change between the groups (p < 0.05). The retromolar space significantly increased in the FRD group compared to the control group (p < 0.05). No significant correlation was found between retromolar space and third molar uprighting in any of the groups (p > 0.05). CONCLUSION: Class II correction with FRD led to mesialization of the lower arch which provided an increase in the retromolar space. Little improvement in the uprighting of the third molars occurred.

Turkish adaptation and implementation of the modified infection control questionnaire in intraoral digital imaging.

PURPOSE: There are very few studies evaluating the knowledge of dentists about infection precautions in oral radiology. The aim of this study was to assess the psychometric properties of the Turkish version of the modified form of a developed questionnaire and to apply this questionnaire to Turkish dentists. MATERIALS AND METHODS: The questionnaire was applied to a sample of 250 dentists for the scale development [200 for confirmatory factor analysis (CFA) and 50 for control] and 173 dentists for the implementation of the scale. The scale was applied to 200 dentists and construct validity was examined with CFA. For model fit; chi square to df ratio, RMSEA (Root Mean Square Error of Approximation), TLI (Tucker-Lewis Index), CFI (Comparative Fit Index), GFI (goodness of fit index), AGFI (adjusted goodness of fit index) and NFI (normed fit index) were obtained. Also, reliability analysis was applied and itemtotal correlations and Cronbach's alpha values were given. Adapted scale scores using a different sample of 173 dentists were compared according to demographic characteristics. RESULTS: CFA showed good fit statistics (X2/df=1.511, RMSEA=0.057, TLI=0.942, CFI=0.953, GFI=0.926, AGFI=0.900, NFI=0.928) for the scale. Item-total correlations were over 0.30 and Cronbach's alpha was calculated as 0.877. In addition, experienced dentists had higher scores in the dimension of personal hygiene (p<0.05). CONCLUSION: The Turkish version of the modified infection control questionnaire in oral radiology showed adequate psychometric properties. This indicated that it could be a valid and reliable tool for the assessment of infection control in oral radiology among Turkish dentists.

Does tooth loss in the mandibular posterior region have an effect on the mental index and panoramic mandibular index?

PURPOSE: Mental index (MI) and panoramic mandibular index (PMI) are important radiomorphometric indices used for assessing the quality of the mandibular bone. The aim of this study was to investigate the possible effect of mandibular posterior tooth/teeth loss in young adults on the MI and PMI (superior panoramic mandibular index: PMI-s, and inferior panoramic mandibular index: PMI-i). MATERIALS AND METHODS: Digital panoramic radiographs belonging to 253 patients aged between 18-35 years old were examined. According to the inclusion criteria of the study, a patient and control group was formed. The patient group (n=46) included individuals having at least one extracted tooth in the posterior region of the mandible, and the control group (n=45) included full dentate patients. The MI and PMI (PMI-i and PMI-s) were calculated bilaterally for all of the individuals. RESULTS: No significant difference was found between the MI, PMI-i and PMI-s indices of the patient group and the control group among both genders. CONCLUSION: The mandibular premolar and/or molar teeth loss in young adults did not lead to any change in the MI, PMI-i and PMI-s indices among both genders.

A pilot study of the effects of a vacuum sealing barrier method for photostimulable phosphor plates regarding plate damage and prevention of microbiologic cross-contamination.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a new sealing method for preventing cross-contamination of photostimulable phosphor (PSP) plates. STUDY DESIGN: Twelve new PSP plates were divided into 3 groups (PSP-a, PSP-b, and PSP- c) and placed in 3 different barriers (2 different brands of envelopes and a vacuum sealing method). All plates were exposed to X-rays with an aluminum step wedge, and the images were evaluated for the presence of any artifacts. After radiography, the PSP plates were removed from the barriers. The barriers and the PSP plates were disinfected and culture performed to assess any microorganism burden. Subsequently, the PSP plates were coated again with all barriers. The barriers were then contaminated and microbiologic specimens were collected. Subsequently, the barriers were wiped with alcohol. The PSP plates were removed, and microbiologic specimens were obtained. RESULTS: No artifacts were recorded on the radiographic images on the sensors in any group. Microorganisms were detected on the PSP plates placed in envelopes. No colonization of microorganisms was detected on the vacuum sealed PSP plates. CONCLUSIONS: The new vacuum-sealing method may be useful in preventing cross-contamination of PSP plates during radiographic procedures.

Dental management and orofacial manifestations of a patient with Robinow Syndrome.

Robinow syndrome (RS) is an extremely rare condition. Characteristic craniofacial findings of RS include a fetal facial appearance, ear abnormalities and oral findings. The aim of this case report was to evaluate the oral findings of a 26-year-old man with RS and to describe the dental treatments performed. The patient had short stature, vertebral anomalies, short and broad fingers, a fetal facial appearance, gingival hyperplasia, fissured tongue, caries and multiple impacted teeth. Periodontal and restorative dental treatments were performed under aseptic conditions with due precautions. No surgical treatment was performed to the impacted teeth because of the lack of symptoms.

Knowledge and behavior of dentists in a dental school regarding toothbrush disinfection.

The aim of this study was to evaluate the knowledge and behavior of dentists regarding toothbrush disinfection. This study included 147 dentists (88 women and 59 men) who were actively employed at a dental school in Ankara, Turkey. Participants were asked to fill out a standard questionnaire, which contained questions regarding their demographics, brushing habits, toothbrush storage and disinfection habits, toothpaste use, knowledge about toothbrush disinfection, and whether they advised their patients about toothbrush storage. Descriptive statistics were calculated, and statistical analyses were performed with t-tests, chi-squared tests, and Fisher exact tests, where appropriate. Among the 147 surveyed dentists, 62.6% and 85.7% reported that they did not have any knowledge about toothbrush disinfection and did not disinfect their toothbrushes, respectively. However, approximately two thirds of surveyed dentists thought that toothbrush disinfection should be performed by everyone, including healthy individuals. Significant associations were found between knowledge about toothbrush disinfection and the professional title of dentists, how they stored their toothbrushes, and whether their toothbrushes were in contact with each other during storage (p < 0.05). A minority of dentists reported that they disinfected their toothbrushes.

Knowledge and behavior of dentists in a dental school regarding toothbrush disinfection

The aim of this study was to evaluate the knowledge and behavior of dentists regarding toothbrush disinfection. This study included 147 dentists (88 women and 59 men) who were actively employed at a dental school in Ankara, Turkey. Participants were asked to fill out a standard questionnaire, which contained questions regarding their demographics, brushing habits, toothbrush storage and disinfection habits, toothpaste use, knowledge about toothbrush disinfection, and whether they advised their patients about toothbrush storage. Descriptive statistics were calculated, and statistical analyses were performed with t-tests, chi-squared tests, and Fisher exact tests, where appropriate. Among the 147 surveyed dentists, 62.6% and 85.7% reported that they did not have any knowledge about toothbrush disinfection and did not disinfect their toothbrushes, respectively. However, approximately two thirds of surveyed dentists thought that toothbrush disinfection should be performed by everyone, including healthy individuals. Significant associations were found between knowledge about toothbrush disinfection and the professional title of dentists, how they stored their toothbrushes, and whether their toothbrushes were in contact with each other during storage (p < 0.05). A minority of dentists reported that they disinfected their toothbrushes.

Influence of gag reflex on removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire.

PURPOSE: To assess removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire (GPA-pa SF) and the influence of gender, education level and prosthesis type and denture-related mucosal irritation on the GPA-pa SF scores before treatment and over a period of two months after prosthesis insertion. MATERIALS AND METHODS: 130 participants who required removable prosthesis were surveyed with a standard form that included questions regarding age, gender, education level, dental attendance, and prosthetic restoration type. Participants answered the GPA-pa SF before restoration (T0) and 1 day (T1), 2 days (T2), 15 days (T3), 1 month (T4), and 2 months (T5) after prosthesis insertion. RESULTS: Of the 130 participants, 110 participants completed the prosthetic restoration procedure, but only 93 of these were able to use the prosthesis over the two-month period. The mean GPA-pa SF score obtained at T0 was higher than the scores obtained at the other periods in the total of the sample. Significant difference was present between mean scores obtained at T0-T1 and T2-T3 than scores obtained at other periods (P<.05). Female participants and participants with denture-related mucosal irritation had higher GPA-pa SF scores at all time points analysed. Significant difference was present between mean GPA-pa SF scores obtained at T2-T3 than scores obtained at other periods for females and participants with denture-related mucosal irritation (P<.05). Education level and prosthesis type did not significantly influence the GPA-pa SF score at any time point analysed (P>.05). CONCLUSION: GPA-pa SF scores were higher before the restoration procedure began, and decreased over time with the use of prosthesis. Gender and denture-related mucosal irritation affected the GPA-pa SF scores.

Teeth number anomalies in permanent dentition among non-syndromic dental patients.

The aim of this study was to establish teeth number anomalies in relation to gender, tooth type, location, distribution pattern and the association between frequently missing teeth among a group of dental patients in Turkey. A total of 378 non-syndromic patients (240 females and 138 males) with an age range of 7-45 (x +/- SD = 22.07 +/- 3.6) having evidence of absent or excess teeth were evaluated in the study. Pearson Chi-square, Fisher's exact, McNemar and Kappa coefficients were used for statistical analysis. 237 patients had a total of 546 congenitally missing teeth and 141 had 185 excess teeth. Congenitally missing teeth were more commonly seen rather than the presence of supernumerary teeth. Difference was determined in the frequent locations of congenital missing and supernumerary teeth. The most frequent missing tooth type was found to be the mandibular second premolar (26.6%), while the majority of supernumerary teeth were located in the anterior region of the maxillary arch (37.9%). Both teeth number anomalies were more commonly seen among females. In hypodontia cases the occurrence of symmetrical agenesis of laterals and second premolars in maxilla; centrals and second premolars in mandible was notable. Agenesis of mandibular centrals was found to be associated with maxillary lateral agenesis in males. Also higher prevalence of molar teeth agenesis was determined in the occurrence of at least 4 teeth agenesis. These findings will serve as information about the contemporary demographic pattern of teeth number anomalies among non-syndromic Turkish dental patients and can provide evidence that agenesis of some teeth symmetrically or together are the products of the same genetic mechanisms.

Assessment of the associated symptoms, pathologies, positions and angulations of bilateral occurring mandibular third molars: is there any similarity?

OBJECTIVE: The aim of this study was to evaluate and establish any similarity between the associated symptoms, pathologies, positions, and angulation types of bilateral occurring mandibular third molars among a group of young adult patients. STUDY DESIGN: A total of 342 patients (167 females, 175 males), aged between 20 and 25 years (mean: 22.2, SD: 1.8) participated in the study. Clinical and radiographic examinations were performed. Eruption status, mucosal and bony coverage type, presence of pain, pericoronitis, suppuration, ulceration, caries in third molar, distal caries in second molar, bone loss, root resorption, or cyst or tumor formation was investigated in addition to the position and the angulation of each tooth. Patients having at least one completely or partially erupted mandibular third molar were classified as group 1 and patients having bilateral impacted mandibular third molars were classified as group 2. RESULTS: No significant difference was found between the symptoms and pathologies related with the mandibular right third molar (RM) and the left third molar (LM) among both groups and genders (P > .05). In the total sample, no significant difference was found between the RM and the LM in terms of mucosal coverage type, bony coverage type, and position both in group 1 and group 2 (P > .05); but gender had an influence on the bony coverage type and ramus distance of the RM and the LM in group 2 (P < .05). In the total the sample, symmetry was present for horizontal or distoangular and vertical or distoangular angulations in group 1 and group 2, respectively. Gender was found to also have an impact on angulation symmetry. CONCLUSION: In most cases, a similarity was present between the symptoms and pathologies related with the bilateral mandibular third molars; but symmetry in position and angulation differed according to eruption status, angulation type, and gender.

Reproducibility and agreement of clinical diagnosis of occlusal caries using unaided visual examination and operating microscope.

AIM: To assess the reproducibility of clinical diagnosis of occlusal caries using unaided visual examination and examination with an operating microscope (16 x magnification) and to determine the agreement between these 2 methods. MATERIALS AND METHODS: Three experienced dentists used unaided visual examination and an operating microscope to grade, according to a standard caries rating scale, a total of 299 occlusal surfaces in 112 subjects (mean age 28.3 years, standard deviation 0.5 years), during several examination sessions. Intraobserver and interobserver reproducibility was calculated, and agreement in diagnosis of the same teeth by different methods was also determined. RESULTS: The level of intraobserver agreement for the 2 modes of clinical diagnosis was substantial, as indicated by kappa values; however, there was substantial interobserver variability with both techniques. Agreement in clinical diagnosis between the 2 techniques was 62.5% for observer 1 (kappa = 0.483), 65.4% for observer 2 (kappa = 0.531) and 63.5% for observer 3 (kappa = 0.508) (p = 0.001). CONCLUSIONS: Intraobserver agreement with the operating microscope and with unaided visual examination was roughly the same, but interobserver agreement was low with both techniques. For some surfaces, the diagnosis made by a particular observer with unaided visual examination differed from that made with microscopic examination. The diagnoses differed most frequently for surfaces that were scored as sound with unaided visual examination.

Dental esthetic satisfaction, received and desired dental treatments for improvement of esthetics.

AIM: The purposes of this research were to investigate factors influencing patients' satisfaction with their present dental esthetic, received previous dental treatments on anterior teeth and basic treatments that they wanted to undergo to improve their dental appearance. MATERIALS AND METHODS: A total of 1014 patients who attended a dental school in a major city in Turkey participated in the study. The participants were surveyed with a questionnaire containing questions about gender, age, education level, self-reported tooth appearance, received previous dental treatments on anterior teeth and desired basic esthetic dental treatments. Statistical analysis of the verifying data was made with descriptive statistics, chi2 test and multiple logistic regression analyses. RESULTS: According to the analyses of the verifying data, 55.1% of the patients were dissatisfied with the color of their teeth, 42.7% with dental appearance, 29.9% with crowding of anterior teeth, 23.3% were hiding teeth while smiling, 16.1% had non-esthetic restorations and 11.9% thought that their anterior teeth were protruding. Esthetic restoration was found to be the most-performed treatment recently (29.0%) and whitening of teeth was the most-desired dental treatment (49.0%). Gender, age and education level had an effect on satisfaction and received previous and desired dental treatments for improvement of esthetics. CONCLUSION: Many of the Turkish patients surveyed in the study were dissatisfied and desired the improvement of dental esthetics. Therefore, dentists should consider this as an important dimension in their practice.

The use of a microscope for restorative treatment decision-making on occlusal surfaces.

Using an operating microscope, this study assessed the effect of 16x magnification on the restorative treatment of posterior teeth and compared the results against an unaided visual examination in vitro. Three dentists examined 300 premolars and molars at different times using an unaided visual examination and an operating microscope at 16x magnification. The observers examined the occlusal surfaces of teeth according to a patient model and selected a treatment protocol based on the following scale: 0: No Active Care (NC); 1: Preventive Care (PC) and 2: Operative Care and Preventive Care (OC+PC) advised. According to the results, there was good intra-observer agreement and moderate interobserver agreement with both techniques. No significant difference was found between the treatment using an unaided visual examination and that using an operating microscope. The use of a microscope at 16x magnification did not aid in the restorative treatment decision-making on occlusal surfaces.

Dietary habits and oral health related behaviors in relation to DMFT indexes of a group of young adult patients attending a dental school.

OBJECTIVES: The aim of the present study was to investigate the dietary habits and oral health related behaviors in relation to the dental health status in terms of decayed, missing and filled teeth (DMFT index) of a group of young adults attending to a dental school located in a major city in Turkey. STUDY DESIGN: A total of 416 young adults (247 females and 169 males) with an age range of 18-25 (Mean 23.2 sd 0.97) attending the Oral Diagnosis department participated in the study. The patients completed a questionnaire including questions about demographic factors, dietary habits and oral health related behaviors. Subsequently, the DMFT index and plaque index was calculated. Descriptive statistics, Mann Whitney U/ Kruskal Wallis Variance analysis, Chi-square/Fisher's Exact tests and multiple linear regression analysis were used for statistical analysis of the data when applicable. RESULTS: According to the results of the study, approximately 70% of the patients had regular main meals and a very high snacking rate (76.9%) was present. Although not at a high rate, most of the patients brushed their teeth regularly twice a day (44.2%) and approximately half used other hygiene aids in addition to brushing (43.8%). The median of the DMFT index was 5 and a majority of the patients had moderate plaque accumulation which could be seen with the naked eye (45.0%). Dental plaque had the most significant effect on the DMFT index. CONCLUSION: In conclusion, advice, including importance of regularity of main meals, decrease in snacking frequency, regular brushing twice a day and the use of other oral hygiene aids for the elimination of dental plaque would be helpful to enhance the dietary habits and oral health related behaviors of young adult Turkish patients.

Dietary habits and oral health related behaviors in relation to DMFT indexesof a group of young adult patients attending a dental school

Objectives: The aim of the present study was to investigate the dietary habits and oral health related behaviors inrelation to the dental health status in terms of decayed, missing and filled teeth (DMFT index) of a group of youngadults attending to a dental school located in a major city in Turkey.Study Design: A total of 416 young adults (247 females and 169 males) with an age range of 18-25 (Mean 23.2 sd 0.97)attending the Oral Diagnosis department participated in the study. The patients completed a questionnaire includingquestions about demographic factors, dietary habits and oral health related behaviors. Subsequently, the DMFT indexand plaque index was calculated. Descriptive statistics, Mann Whitney U/ Kruskal Wallis Variance analysis, Chi-square/Fisher’s Exact tests and multiple linear regression analysis were used for statistical analysis of the data when applicable.Results: According to the results of the study, approximately 70% of the patients had regular main meals and a veryhigh snacking rate (76.9%) was present. Although not at a high rate, most of the patients brushed their teeth regularlytwice a day (44.2%) and approximately half used other hygiene aids in addition to brushing (43.8%). The median ofthe DMFT index was 5 and a majority of the patients had moderate plaque accumulation which could be seen withthe naked eye (45.0%). Dental plaque had the most significant effect on the DMFT index.Conclusion: In conclusion, advice, including importance of regularity of main meals, decrease in snacking frequency,regular brushing twice a day and the use of other oral hygiene aids for the elimination of dental plaque would behelpful to enhance the dietary habits and oral health related behaviors of young adult Turkish patients (AU)

Dental fear and anxiety levels of patients attending a dental clinic.

OBJECTIVE: The aim of this study was to evaluate the anxiety levels of patients attending a university oral diagnosis clinic. Avoidance, felt physiologic responses, and the most fear-producing stimuli of dental treatment were also evaluated. METHOD AND MATERIALS: A total of 1,437 patients were asked to complete a questionnaire consisting of the Dental Anxiety Scale (DAS), Dental Fear Scale (DFS), and questions about age, gender, education level, and frequency of dental visits. The patients were grouped according to gender and divided into 5 age categories. Statistical analysis was made by descriptive statistics, two-proportion z test, analysis of variance, Tukey's Honestly Significant Difference test, and Scheffé test. RESULTS: The mean DAS score was 9.52 (SD 4.08) for females, 7.96 (SD 3.30) for males, and 8.76 (SD 3.80) for the total sample. There was no statistically significant difference between the mean DAS scores of age groups. Patients with a primary school education and those who had never visited the dentist had the highest anxiety scores. According to the DFS, the most felt autonomic response was increased heart rate, and the most fear-producing stimuli were the sight of the needle (25.1%) and sensation of the injection (24.1%). Of the patients 10.5% avoided calling for an appointment, and 4.9% canceled or did not appear for appointment. CONCLUSION: Some patients are afraid of some of the stimuli involved with dental treatment. This could affect the patient-dentist relationship and the dental treatment plan; therefore, before dental treatment, patients' anxiety and fear levels should be assessed.

Restorative treatment decision making with unaided visual examination, intraoral camera and operating microscope.

This study assessed the restorative treatment options of the occlusal surfaces of teeth examined with unaided visual assistance, an intraoral camera and an operating microscope. Sixty-eight extracted human molars were mounted to perform mouth models with a premolar in contact on both sides. Four observers examined the models in a phantom head, which simulated clinical conditions, using three techniques: unaided visual examination, intraoral camera and operating microscope. The observers were asked to assess the occlusal surface of each tooth and make a treatment decision based on the following scale: 1) the occlusal surface being sound and "not needing a restoration," 2) the occlusal surface having a subsurface or enamel lesion. No operative treatment was needed at this visit, but special attention was given to this surface at recall visits: "preventive care-defer treatment" and 3) the surface had a carious lesion and "needed a restoration." The teeth were then sectioned in the mesio-distal direction and examined under a stereomicroscope with 10x magnification to determine the true extent of caries. Statistical analysis was conducted by calculating percentages and kappa values of the restorative treatment scores based on examinations by four observers. According to all the observers' treatment decisions, the kappa values were found to be 0.341 (p<0.001), 0.471 (p<0.001) and 0.345 (p<0.001) for unaided visual examination, intra-oral camera and operating microscope, respectively. There was a statistically significant difference between the intraoral camera and the other two methods (p<0.05), while there was no significant difference between the unaided visual examination and operating microscope (p>0.05). As a result of a comparison between the unaided visual examination and operating microscope, the use of an intraoral camera improved the restorative treatment decisions of the occlusal surfaces on posterior teeth.