Use of acronyms in the patient dental record.

The patient dental record is a legal document that captures the history of patient care for a particular patient. This article references the American Dental Association's listing of common dental abbreviations, symbols and acronyms, which aid in establishing uniformity for clinicians.

Isolation and genotypic comparison of oral streptococci from experimental bitemarks.

The feasibility of recovering and genotypically comparing oral bacteria from bitemarks for forensic purposes was assessed experimentally. Volunteers firmly bit their own upper arms and bitemarks were sampled at intervals to recover viable Streptococcus isolates. The recoverability of bacteria decreased over time but an average of more than one thousand viable organisms was recovered 24 hrs after biting, provided the site remained relatively undisturbed. Physical exertion, manual rubbing and application of moisturizing lotion all decreased bacterial recoverability compared to controls. Streptococci could also be recovered from bites inflicted on various fabrics. Genomic profiles (DNA "fingerprints") of bacteria recovered from bitemarks could be identified exclusively with those from the teeth of the individual responsible. These findings suggest that a bacterial genotyping approach to bitemark analysis could have forensic application in situations where the perpetrator's DNA cannot be recovered from an oral contact site.

Retrieval technique for fractured implant screws.

Fractured screws generally are challenging to remove. The technique described in this article involves the use of inexpensive instruments commonly found in dental offices. The force required to remove the broken screw is minimal provided that the screw threads have not been damaged previously. A high degree of manual dexterity is required, however, to prevent damage to the implant itself; thus, this may not be the procedure of choice for inexperienced practitioners.

Bleaching and temporomandibular disorder using a half tray design: a clinical report.

A maxillary soft, custom-fitted tray was fabricated for a patient to perform nightguard vital bleaching. Treatment was interrupted after the patient experienced pain in the temporomandibular joint area shortly after wearing the bleaching prosthesis. The tray was trimmed so the labial, incisal and buccal cusps were covered and Sc) the patient had complete tooth-to-tooth contact in the maximum intercuspal position. The prosthesis proved to be retentive even without the presence of the bleaching material. The thick, sticky bleaching material was contained in the half tray design and the tray was held in place. The patient was able to continue the bleaching process for the 2-week duration necessary to achieve successful lightening of the teeth without further TMD symptoms.

Thermal stability of direct dental esthetic restorative materials at elevated temperatures.

With increasing use of direct esthetic restorative materials, the identity of a body may rely upon knowledge of temperature effects on this class of dental restorations. This research examined the effect of atmospheric gas on thermal decomposition and color change of a wide variety of direct esthetic restorative materials. Cured discs (4 x 1 and 8 x 1 mm) were made using manufacturer's directions: traditional glass ionomer (Fuji II), light-curable resonomer (Fuji II LC), compomer (Geristore), and three types of resin composites--highly filled, urethane-based (Occlusin), and two Bis-GMA/TEGDMA resins: hybrid (Herculite XRV) and microfill (Silux Plus). Three replications of each material were heated at 5 degrees C/min in a thermogravimetric analysis unit using either room air or nitrogen purge to simulate different thermal environments. First derivative values of percent weight loss with respect to temperature were obtained to determine temperatures associated with increased decomposition rates. Room-air heating showed greater numbers of decomposition events than did nitrogen-heated discs. The only material decomposing less than 200 degrees C in either atmosphere was traditional glass ionomer. The majority of decomposition occurred between 200 degrees and 500 degrees C for all materials. Only products containing glass ionomer components decomposed between 600 degrees and 800 degrees C. Room-air heating resulted in ash white discs at 800 degrees C and higher. Specimens heated in nitrogen were gray to black at 600 degrees C and higher. Heating atmosphere greatly affected color, and some products demonstrated distinguishing color changes: glass ionomers, in particular, showed characteristic color features. An atlas was constructed from color change of specimens recovered after 200 degrees, 400 degrees, 600 degrees, 800 degrees, and 1000 degrees C compared with non-heated controls.

Dental practices that aid the general practitioner and forensic dentist.

There are practices that improve the efficiency of a general dentistry office and may aid a forensic dentist in making an identification. These practices include maintaining current dental charts, using the accepted post-mortem charting nomenclature, and maintaining quality radiographs as well as complete and legible progress notes.

Effect of 10 percent carbamide peroxide on color of provisional restoration materials.

To improve esthetic results, nightguard vital bleaching of teeth using 10 percent carbamide peroxide, or CP, may be indicated when an anterior tooth is restored with a provisional crown. This study evaluated the effect of NGVB solutions containing 10 percent CP on the color stability of provisional restoration materials. Disks were fabricated from six representative provisional restoration materials and were tested in five different 10 percent CP bleaching agents. An orange discoloration occurred with provisional materials that contained methacrylate when they were exposed to 10 percent CP bleaching solutions.

Lipopolysaccharide affinity for titanium implant biomaterials.

STATEMENT OF PROBLEM: Lipopolysaccharide (LPS) affinity for titanium implant biomaterials could affect crevicular LPS concentrations and thereby influence periimplant inflammation. PURPOSE OF STUDY: The purpose of this study was to evaluate Porphyromonas gingivalis and Escherichia coli LPS affinity for titanium biomaterials groups that differed in surface oxide composition and surface roughness. MATERIAL AND METHOD: Polished and abraded grade 1 commercially pure titanium and grade 5 alloyed extra low interstitial titanium specimens were treated with 10 EU/mm2 and radiolabeled LPS. RESULTS: The resultant mean +/- SD LPS adherence values ranged from 4.17 +/- 0.29 to 4.79 +/- 0.40 EU/ mm2. No difference in adherence and elution was indicated on the basis of LPS type, surface oxide composition, or surface roughness. Moreover, P. gingivalis and F. coli LPS desorption was below detection. CONCLUSION: Clinically, the high affinity of both LPS types for titanium biomaterials may adversely influence the periimplant tissue response.

Vital tooth bleaching with Nightguard vital bleaching.

Between July 1994 and May 1996, several landmark articles were published concerning the safety and efficacy of vital tooth bleaching with 10% carbamide peroxide in a customfitted tray. The American Dental Association (ADA) published guidelines for ADA acceptance, and three products received approval. Long-term clinical trials on 38 patients indicated 92% successful bleaching after 6 weeks of treatment. Results were stable in 74% of the patients at 1.5 years, and in 62% of the patients at 3-year follow-up with no further treatment. Clinical pulpal studies and periodontal studies indicated no detrimental safety problems, although some laboratory cell studies suggested concerns. The noncarcinogenic potential of 10% carbamide peroxide was established in animal studies. Successful bleaching of tetracycline-stained teeth was achieved after 6 months of treatment, with no tooth problems detected clinically or by scanning electron micrograph. Extended treatment times are effective on other stains from dentinogenesis imperfecta or nicotine. On insertion in the mouth, 10% carbamide peroxide elevated the pH in the tray and saliva. After 4 hours of clinical wear, over 60% of the newer, thicker materials (Opalescence [Ultraclent Products, South Jordon, UT] and Platinum [Colgate Oral Pharmaceuticals, Canton, MA]) was present and active in the tray. Nightguard vital bleaching seems to be the most cost-efficient, user-friendly, patient-accepted method of bleaching teeth available to the profession and is safe and effective. Over-the-counter products can have harmful effects on tooth structure and may not lighten teeth.

Relationship between serum concentrations, hemodynamic effects, and cardiovascular lesions in dogs treated with minoxidil.

The threshold hemodynamic changes associated with the cardiovascular (CV) toxicity of minoxidil (MNX) in the dog, characterized by subendocardial necrosis, right atrial hemorrhagic lesions, and coronary vascular medial hemorrhage and necrosis, have not been defined. To determine the relationship between serum concentration, hemodynamic effects [heart rate (HR) and mean arterial pressure (MAP)] and CV toxicity, groups of female Beagle dogs were treated with a continuous iv infusion of dextrose (control) or 0.05, 0.14, 0.43, 1.44, or 4.32 mg/kg/day of MNX for 3 days. Serum concentration of free MNX increased in a dose-related manner and reached steady state within 4 hr after the initiation of infusion. There was a time-dependent, apparently dose-related increase in HR at all doses. MAP was decreased at > or = 0.14 mg/kg/day in a time- and dose-related manner. The doses or steady-state serum concentrations of MNX that showed no significant hemodynamic effects and CV toxicity were approximately 0.05 mg/kg or 3.0 +/- 0.6 ng/ml and 0.14 mg/kg or 7.3 +/- 2.0 ng/ ml, respectively. CV toxicity occurred at a serum concentration of 16.6 +/- 1.9 ng/ml where HR was increased by 65 +/- 11 beats/min and MAP was decreased by 34 +/- 2 mm Hg. A serum concentration of 7.3 +/- 2 ng/ml of MNX that increased HR by 47 +/- 14 beats/min and decreased MAP by 17 +/- 8 mm Hg was not associated with CV toxicity. This study suggests that the threshold hemodynamic effects associated with the CV toxicity of MNX in the dog are a function of an increase in HR by at least 55 beats/min and a decrease in MAP by at least 30 mm Hg. In conclusion, the safety margin of drugs like MNX, where the mechanisms of toxicity are known to be related to their pharmacologic effects, should be based on the ratio of the pharmacokinetically and metabolically adjusted dose/serum concentration of the drug that evokes comparable pharmacologic effects in the animal model and humans rather than on the ratio of the nontoxic dose/serum concentration in animals to the efficacious dose in humans.

Porphyromonas gingivalis endotoxin affinity for dental ceramics.

This study evaluated the effects of chemical composition, surface treatment, and initial exposure dose on Porphyromonas gingivalis lipopolysaccharide adherence to and elution from dental ceramics. Lipopolysaccharide, commonly known as endotoxin, can initiate a variety of biologic responses. Opaque, body, and Dicor ceramic disks were individually exposed to 250, 1000, or 2500 EU/ml 3H-lipopolysaccharide and incubated for 24 hours at 37 degrees C. Disks were then transferred to fresh lipopolysaccharide-free water and incubated for up to 96 hours to evaluate elution. Mean initial lipopolysaccharide adherence ranged from 0.397 +/- 0.048 EU/mm2 to 5.056 +/- 0.117 EU/mm2. Greater initial exposure levels resulted in greater adherence, and at higher lipopolysaccharide exposure levels, lipopolysaccharide adherence differences were based on ceramic type. Mean lipopolysaccharide elution levels ranged from 0.063 +/- 0.02 EU/mm2 to 0.00 EU/mm2 at 96 hours for all groups. Greater initial adherence resulted in greater elution. Ceramic type did not affect elution. Surface finish affected elution at the 2500 EU exposure level. The affinity of lipopolysaccharide for dental ceramics could contribute to a periodontal inflammatory process.

The pharmacologic basis of the cardiovascular toxicity of minoxidil in the dog.

Minoxidil (MNX), like several other vasoactive drugs, causes cardiovascular toxicity in dogs by undetermined mechanisms. We studied the mechanism of cardiovascular toxicity of MNX [an adenosine triphosphate (ATP)-sensitive potassium channel opener] by blocking its pharmacologic effects with glyburide (an ATP-sensitive potassium channel blocker) in groups of 5 female beagle dogs treated orally for 2 days with 1.0 mg/kg/day of MNX alone or with glyburide given in 5 or 6 divided doses of 300 mg/kg at 2 hr before and after each dose of MNX and at 3-6-hr intervals thereafter. A third group of 5 dogs received glyburide alone in the same dosing regimen as in the combination group. Mean arterial pressure (MAP), heart rate (HR), the pharmacokinetics of MNX, and gross and microscopic changes in the heart were evaluated. Glyburide did not influence the pharmacokinetics of MNX but prevented or markedly attenuated the MNX-induced cardiovascular lesions (right atrial hemorrhagic lesions, subendocardial necrosis, or coronary arteritis) occurred in dogs whose MNX-induced hemodynamic effects were effectively blocked by glyburide. In conclusion, the cardiovascular toxicity of MNX in dogs is not caused by a direct toxic effect of MNX on the heart but apparently is related to the exaggerated pharmacologic/profound hemodynamic effects it elicits in the dog.

Prospective investigation of the single-crystal sapphire endosteal dental implant in humans: ten-year results.

This study conducted a longitudinal prospective clinical study of the single-crystal sapphire (Al2O3) cylindrical screw-shaped endosteal dental implant, and attempted to establish clinical parameters to evaluate implant success or failure. Twenty-eight mandibular implants (17 patients) were placed. After six weeks' healing, 23 implants in 15 patients served as distal abutments for fixed prostheses (baseline). Implants were evaluated for bleeding index, crevicular fluid volume index, plaque accumulation index, radiographic index, mobility index, and patient comfort. Any implant failing in three of these criteria or implants removed were judged as failures. After 10 years, of the 21 baseline implants recalled (two implants were lost to recall), 17 were fully functional, for an 81% success rate. The use of qualitative and quantitative clinical evaluation parameters as utilized in this study appears to be important and useful in assessments of the clinical serviceability of dental implants. These parameters can be used in human clinical trials as well as in experimental animal studies.

Effects of nutritional supplementation on bone mineral status of children with rheumatic diseases receiving corticosteroid therapy.

OBJECTIVE: Because children with rheumatic disease receiving longterm corticosteroids are at high risk for developing osteoporosis, we attempted to determine whether nutritional supplementation would improve bone status in this group of children. METHODS: In a crossover design study, 10 corticosteroid treated children with rheumatic disease and osteoporosis received calcium and vitamin D supplementation for 6 months to determine their effect on bone density. They were then studied for 6 months without added nutrition supplements. The mean age was 13.1 years with a mean duration of disease of 4.2 years. Six patients had juvenile rheumatoid arthritis, 2 had systemic lupus erythematosus and 2 had mixed connective tissue disease. These children obtained a minimum of 1 g of calcium and 400 IU of vitamin D daily from diet and added supplements. Dual photon absorptiometry, laboratory and dietary data were obtained at baseline, 6 months, and one year. RESULTS: Spinal bone density significantly improved with supplementation. Osteocalcin values remained low throughout the study. CONCLUSION: Our results suggest some children with rheumatic disease receiving corticosteroids would benefit from calcium and vitamin D supplementation.

Rat adrenal cortex is a source of a circulating ouabainlike compound.

To determine if the adrenal gland may be the source of plasma-borne ouabainlike compound (OLC) in rats, we 1) measured immunoreactivity expressed as OLC equivalents in extracts from a wide variety of central and peripheral tissues and, for adrenal cortex and medulla, chromatographed the extracts to determine to what extent immunoreactivity in the adrenal was OLC, and 2) measured OLC in the plasma of adrenalectomized and adrenal demedullectomized rats. The highest levels of immunoreactivity were found in adrenal cortex, adrenal medulla, atria, and the pituitary. Based on high-performance liquid chromatographic retention time, immunoreactivity in the adrenal cortex was almost exclusively immunoreactive OLC. Removal of this rich source of OLC from rats resulted in an approximate 50% decrease in circulating levels of OLC by 6 days after removal. Furthermore, although adrenal demedullectomy also caused a decrease in OLC 3 days after surgery, the decline was sustained only with total adrenalectomy, in that plasma levels of OLC in demedullectomized rats 6 days after surgery had returned to levels equal to those of sham controls. Taken together, these findings strongly suggest that the adrenal cortex is a major contributor to circulating OLC in the rat.

Bronchopulmonary and cardiovascular effects of prostaglandin D2 in the dog.

The effects of intravenously administered prostaglandin D2 (PGD2) on bronchopulmonary and cardiovascular functions were examined in the dog. PGD2 (0.03-1.0 microng/kg) was shown to be more active than PGF2alpha, a known bronchoconstrictor, in decreasing dynamic lung compliance, tidal volume, and expiratory airflow rate, as well as in elevating lung resistance. PGD2 demonstrated a potency approximately 4-6 times that of PGF2alpha on pulmonary mechanics. Atropine sulfate infusions reduced significantly the resistance and compliance responses to PGF2alpha, but only the resistance responses to PGD2, thereby suggesting that part of the bronchoconstrictor activities of these agents involved a cholinergic component. In another series of anesthetized dogs, PGD2 (0.1-10.0 microng/kg) increased pulmonary arterial pressure (comparable to PGF2alpha) and heart rate (greater than PGF2alpha, but less than PGE2), while concomitantly decreasing systemic arterial pressure in a dose-related manner (1/10 that of PGE2). Qualitatively similar alterations in cardiovascular parameters were obtained for PGD2 in conscious dogs. Therefore, potent biologic activity of PGD2 has been shown in the dog. No physiologic or pathologic role for PGD2 has yet been demonstrated, but nonetheless, since it is a naturally occurring PG derived from arachidonic acid, further studies are warranted.