Exploring acupuncturists' perceptions of treating patients with rheumatoid arthritis.

AIMS: To outline acupuncturists' perceptions of treating patients with rheumatoid arthritis (RA), exploring the impact of practitioner affiliation to a traditional or western theoretical base. METHODS: Qualitative study utilising Grounded Theory Method. Nineteen acupuncturists were chosen via theoretical sampling. In-depth semi-structured interviews were tape-recorded and transcribed. Field notes were also taken. Emerging categories and themes were identified. RESULTS: Inter-affiliatory differences were identified in the treatments administered and the scope and emphasis of intended therapeutic effects. Limited divergence was found between acupuncturists' perceptions of treatment outcomes. Factors perceived as impacting on treatment outcomes were identified. CONCLUSIONS: Clinical trials of acupuncture in RA may have failed to administer a treatment which reflects that administered in clinical practice. Outcome measures employed in clinical trials of acupuncture in RA, as well as established outcome indices for RA, may lack the necessary breadth to accurately assess acupuncture's efficacy. Acupuncturist affiliation has demonstrable implications for the practice and research of acupuncture.

Ultraconservative and cariostatic sealed restorations: results at year 10.

Changes in restorative techniques and the development of newer restorative materials have allowed for the use of more conservative cavity preparations. This 10-year study evaluated bonded and sealed composite restorations placed directly over frank cavitated lesions extending into dentin vs. sealed conservative amalgam restorations and conventional unsealed amalgam restorations. The results indicate that both types of sealed restorations exhibited superior clinical performance and longevity compared with unsealed amalgam restorations. Also, the bonded and sealed composite restorations placed over the frank cavitated lesions arrested the clinical progress of these lesions for 10 years.

Computer-assisted densitometric image analysis (CADIA) of previously sealed carious teeth: a pilot study.

Previous studies have shown that occlusal dental caries can be arrested with sealants. Radiographic monitoring must be performed to ensure success. Standardized sequential bitewing radiographs over a 10-year interval of four patients who had sealed composite restorations placed without caries removal were digitized and analyzed using the CADIA algorithm. CADIA values for the 10-year period were analyzed using Analysis of Variance (ANOVA), and showed no significant change in radiographic density for this interval (P > 0.05), which is suggestive of arrested dental caries.

Cariostatic and ultraconservative sealed restorations: nine-year results among children and adults.

The objective of this clinical study was to evaluate the long-term efficacy of placing sealed posterior composite restorations for arresting active caries. The tooth preparation for this bonded and sealed restoration was limited to placing a bevel in the enamel only, without the removal of the carious lesion. The radiographic and clinical performance of these ultraconservative sealed composite restorations placed over caries (CompS/C) was compared over a period of nine years with: 1) ultraconservative, localized sealed amalgam (AGS) restorations with no extension for prevention, and 2) traditional, unsealed amalgam restorations (AGU) with the usual extension for prevention outline form. Sealant retention with > 50 percent to 100 percent of the margins occurred in 64 percent of CompS/C and 82.5 percent of AGS restorations. After nine years the cumulative failure rates were 16 percent for CompS/C, 2.5 percent for AGS, and 17.1 percent for AGU restorations. Thus, the clinical performance of CompS/C restorations was slightly superior to that of the traditional AGU restorations. The AGS restorations were definitely superior to the traditional AGU restorations and to the CompS/C restorations in both children and adults alike. Complete sealant retention over CompS/C and AGS restorations was equivalent between children and adults (P = 0.14 and 0.74, respectively). A higher percentage of open margins in CompS/C restorations was seen, however, in children (17.4 percent) than adults (1.94 percent). This study has shown that Class I caries can be arrested by the CompS/C restoration.

Cariostatic and ultraconservative sealed restorations: six-year results.

The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. Tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear.

Sealed restorations: 5-year results.

This clinical study determined the feasibility of a sealed resin composite restoration to arrest dental caries using a minimal tooth preparation: a bevel in enamel only without removal of the carious lesion. These ultra-conservative sealed composite restorations placed over caries (CompS/C) were compared with ultra-conservative sealed amalgam restorations (AGS) that had no "extension for prevention". The CompS/C restorations were also compared with the traditional (unsealed) amalgam restorations (AGU) with the "extension for prevention" outline form. Caries progress, as determined by standardized radiographs, revealed that after 5 years caries remained arrested under the CompS/C restorations; the marginal integrity was similar for the CompS/C and the AGS groups, and exhibited highly significant superiority to the AGU restorations (Chi square, P less than = 0.00004). Complete sealant retention over the amalgam restorations (AGS group) was less than over the composite restorations (CompS/C), and conversely, partial sealant retention was higher for the AGS group. Sealants also appeared to protect the posterior composite restorations against wear.

Sealed restorations: 4-year results.

The overall objective of this clinical study was to determine the feasibility of using a sealed composite restoration to arrest caries. This objective was to be achieved using minimal tooth preparation for Class I lesions, without the traditional Class I cavity preparation and without the removal of the carious lesion. The minimal tooth preparation consisted of no [corrected] removal of the carious lesion, bevel in enamel only, and usually not requiring any anesthetic injection. These ultra-conservative sealed composite restorations placed over caries (CompS/C) were compared with ultra-conservative sealed amalgam restorations (AGS) and with the traditional (unsealed) amalgam restorations (AGU). This study showed that: 1) caries is arrested under the CompS/C restoration for a period of 4 years; 2) sealant retention is similar in both the CompS/C and the AGS groups; 3) the marginal integrity of the AGS restorations is markedly superior to that of the AGU restorations; and 4) sealant appears to prevent wear of posterior composite restorations.

Ultraconservative sealed restorations: three-year results.

The overall objective of this clinical study was to determine the feasibility of using a sealed composite restoration to arrest caries without the removal of the carious lesion and without the traditional cavity preparation. The minimal tooth preparation (a bevel in enamel) usually did not require any anesthetic injection and conserved tooth structure. These ultraconservative sealed composite restorations placed over caries (CompS/C) have been compared with ultraconservative sealed amalgam restorations (AGS) and with the traditional outline form (unsealed) amalgam restorations (AGU). This clinical study has shown that: (1) caries can be arrested by the CompS/C restoration for a period of three years; (2) the marginal integrity of the AGS restorations showed a definite trend toward improvement as compared to the AGU restorations; and (3) complete sealant retention over posterior restorations was similar in both the CompS/C and the AGS groups during the first two years; however, at Year 3 complete sealant retention was 16 percent higher in the CompS/C than in the AGS group.

Clinical performance of sealed composite restorations placed over caries compared with sealed and unsealed amalgam restorations.

The 2-year clinical evaluations of paired occlusal restorations are presented. Each study participant received a sealed composite restoration placed over a carious lesion and either a traditional outline-form (unsealed) amalgam or an ultraconservative sealed amalgam restoration. Caries was removed before placement of both types of amalgam restorations. No important clinical differences developed among the three groups of restorations.

Arresting caries by sealants: results of a clinical study.

In each of 14 patients, one bilateral occlusal carious lesion was sealed and the other lesion was left open as a control. The control lesions showed patterns of sudden increases in cavity depth, as well as evidence of being active bacteriologically; whereas, with one exception, the sealed lesions were inactive bacteriologically. The residual carious material in the sealed lesions suggested a complete cessation of the carious process. No clinical or radiologic signs were seen to suggest that the health of the sealed tooth had been compromised.

Hydration of the stratum corneum.

Synopsis Topically applied water, occlusion and topically applied glycerol were used to investigate and characterize some of the changes which occur in the hydrated stratum corneum. The effects of these treatments were monitored using non-invasive techniques under controlled conditions. The Servomed Evaporimeter was used to determine natural water flux from the skin surface before and after treatment. The performance of the Evaporimeter in this type of study had previously been improved by attaching a paper baffle to the detector. This eliminated the variance in output caused by atmospheric movement. Experiments were carried out at temperatures below the threshold of thermal sweating and emotional sweating was minimized. Skin surface topography was characterized by means of a new type of profilometer. The instrument's design allowed a diamond stylus to traverse the living skin surface without significantly altering its structure. Changes in skin surface roughness were further elucidated using scanning electron microscopy and macrophotography. In vivo penetration of glycerol was assessed by chemical analysis of stratum corneum layers of treated skin. Samples were obtained by sequential stripping of the stratum corneum using adhesive tape. Topically applied water produced only a transient benefit because of rapid evaporation. More prolonged hydration was achieved by suppressing transepidermal water loss with polyethylene film. This occlusive hyperhydration was characterized by a significant reduction in profile roughness and by a smoother macroscopic appearance. Glycerol achieved the same effects by reducing the magnitude of the natural water flux from the skin surface and by reducing the rate of evaporation of water from applied aqueous glycerol solution or cosmetic product. Both effects were seen as the result of lowered water activity in the proximity of glycerol. Smoothing effects of glycerol on the skin surface, and improved appearance, persisted for at least 24 h. This persistence was explained by evidence for diffusion of glycerol into the stratum corneum where it formed a reservoir. Hydration of the skin is known to affect its barrier function and thereby exert a profound effect on penetration of both lipophilic and hydrophilic molecules. Clinically, this effect may be achieved using liberal applications of occlusive petroleum jelly and ointments. The results presented in this paper suggest that the use of humectants could achieve useful hydration using cosmetically acceptable materials.

A comparative clinical study of two pit and fissure sealants: 7-year results in Augusta, GA.

This 7-year evaluation of the Augusta study reinforces earlier conclusions regarding the long-term retention of sealants and their efficacy in caries protection. Although more time will be required to answer all the questions about sealants, sufficient data are now available to document their efficacy as caries-preventive agents. It is imperative that the dental profession provide this safe and effective preventive technique for the public so that dental disease can either be reduced or further postponed.

A comparative study of two pit and fissure sealants: results after 4 1/2 years in Augusta, Ga.

A total of 220 children were examined at 4 1/2 years (54 months) after a single application of a pit and fissure sealant. In 110 children, 177 permanent first molars were treated with Nuva-Seal; and in 110 children, 168 permanent first molars were treated with Delton. Nuva-Seal was completely retained on 35% of all paired permanent molars, partially retained on 21%, and completely lost on 44% of the study teeth. Delton was completely retained on 72% of all paired permanent molars, partially retained on 14%, and completely lost on 14% of the study teeth. These data indicate that occlusal caries protection on permanent molars is assured if the sealant is completely retained on the tooth. Delton was four times more effective in providing protection against pit and fissure caries than Nuva-Seal.