Case report of self-injurious behaviour (SIB) presenting as gingivitis artefacta major.

The case report described here discusses gingivitis artefacta major, an oral presentation of self-injurious behaviour, in an adolescent. On presentation, the patient knew well the ramifications of her gum scratching behaviour, however, was unable to stop. At further presentations new lesions had appeared with further bone loss. The cause of her behaviour seemed to be of psychological origin and therefore no interventive dental treatment was possible until this issue was resolved. A more preventive approach was adopted in the meantime. Referral to appropriate services from the dental profession also proved to be challenging. In conclusion, gingivitis artefacta, although rarely seen to this extent, is extremely challenging to diagnose and treat fully in a dental setting.

The availability and content of dental instrument manufacturers' decontamination information.

OBJECTIVE: The effective decontamination of reusable dental instruments is essential to reduce the risks from onward transmission of infectious diseases. There are therefore a number of legislative requirements placed upon manufacturers of medical devices (which includes dental instruments) to provide validated methods for the reprocessing of such devices. The aim of this study was to determine the availability and content of manufacturer's instructions for the reprocessing of reusable dental instruments. MATERIALS AND METHODS: A database of reusable dental instruments with details of their manufacturers was collated from information received from three dental hospitals. A questionnaire was sent to all the manufacturers requesting information about the reprocessing instructions for their products. The response from each manufacturer was assessed for the quality of the information and compliance with the British, European and International Standard, BS EN ISO 17664 (2004). RESULTS: The database from the three dental hospitals included over 800 items supplied by 54 different manufacturers/suppliers. Forty protocols were available for assessing compliance with BS EN ISO 17664 (2004). These protocols accounted for 25 (46%) manufacturers covering 300 devices. The majority (90%) of the returned questionnaires did not comply with the required standard and provided insufficient information to allow for the effective decontamination of the instruments. CONCLUSIONS: Manufacturers of medical devices are legally required to supply the user with validated instructions to enable effective decontamination of these devices. The information must be in a format as specified in BS EN ISO 17664 (2004). The information obtained in this survey demonstrated that the manufacturers' instructions fall short of the required regulatory requirements. The absence of such instructions increases the risk of cross-infection arising from inadequate cleaning, decontamination and sterilisation.

The dental management of adult patients with haemophilia and other congenital bleeding disorders.

The management of adult dental patients with congenital bleeding disorders has caused a considerable number of problems to the dental profession. There is a need to simplify the process and identify what can be safely carried out on a 'shared care' basis in General Dental Practice or the Community Dental Service. Particular problems are discussed with special reference to those requiring hospital care. The Scottish Oral Health Group for Medically Compromised Patients has developed this clinical guidance in conjunction with the Scottish Haemophilia Directors. It is important that dental care is easily available for this group of patients, especially those living at some distance from the regional centres. The aim is to simplify planning dental care for this group of patients and remove a number of myths concerning their management. The hospital departments, both medical and dental, must be available for advice and to arrange for treatment that is inappropriate outside a specialist hospital.

The influence of three Erbium:YAG laser energies on the in vitro microleakage of Class V compomer resin restorations.

OBJECTIVES: To investigate the influence of three Erbium:YAG pulse energies (200 mJ, 240 mJ, and 300 mJ with a 100 mJ dentine finish) on the microleakage of Class V compomer restorations (Compoglass). DESIGN: In vitro study. SAMPLE AND METHODS: Sixty-one extracted human premolar teeth were randomly allocated to three groups (according to pulse energy). Each tooth hosted one test cavity prepared with one of the three Er:YAG pulse energies using a pulse repetition rate of 5 Hz and a pulse duration of 250 microseconds, and one control cavity prepared with a conventional diamond bur in a high-speed hand piece. Both cavities were placed at the cervical margin of the tooth and were restored and finished according to the manufacturer's instructions. Each tooth was then stored in 0.12% thymol solution at 37 degrees C for three months, before being thermocycled through water baths between 5 degrees C and 55 degrees C for 240 cycles. Microleakage was assessed using a methylene blue dye penetration technique and was quantified using a score 0 (none) to 4 (to and into the axial wall). The data was analysed using the Kruskal-Wallis and Mann-Whitney U-tests. RESULTS: Leakage was seen in all groups at both the dentine and enamel margins. There were no statistically significant differences in leakage (P < 0.05) at either the enamel or dentine margins, except for the 240 mJ lased enamel margins. This group performed significantly better than the enamel margins prepared with 200 mJ (P = 0.03) and the 300/100 mJ (P = 0.01) laser energies as well as the conventionally prepared enamel margins (P < 0.001). CONCLUSION: Cavity preparation with this Erbium:YAG laser did not influence the microleakage of Compoglass restorations adversely. Different pulse energies were required for optimum cavity sealing at the enamel and dentine margins and for different materials.

Influence of Erbium:YAG laser energies on the microleakage of Class V resin-based composite restorations.

PURPOSE: To evaluate the influence of three Erbium:YAG laser energies on the microleakage of Class V resin-based composite restorations. MATERIALS AND METHODS: 60 extracted human premolar teeth stored in 0.12% thymol solution were randomly allocated to three groups. Buccal and lingual box-shaped Class V cavities were prepared on each tooth. One cavity served as the control and was cut using a conventional diamond bur in a high-speed handpiece. The test cavity was prepared using a pulse repetition rate of 5 Hz with 1 of 3 pulse energies; 200 mJ, 240 mJ, and 300 mJ with a 100 mJ dentin finish. The cavities were restored with Scotchbond Multi-Purpose and Z100 and were finished immediately before being stored for 3 months in thymol solution at 37 degrees C. Following thermocycling between 5 degrees C and 55 degrees C for 240 cycles and a further 12 hrs storage, the teeth were immersed in a 2% aqueous solution of methylene blue for 24 hrs. They were then sectioned through the mid-point of the restorations in a bucco-lingual plane and dye penetration was scored as 0 (none) to 4 (to the axial wall) for the enamel and dentin margins of both sections. The worst score for each margin was used for statistical analysis using the Kruskal Wallis and Mann-Whitney U tests at P < 0.05. RESULTS: When the lased groups were compared, optimum sealing was achieved with energies of at least 240 mJ at the enamel margin and with energies no higher than 200 mJ to finish the dentin margin. However, while all the pulse energies compared favorably to the control group in enamel, a similar result was found only using the 300 mJ, with 100 mJ, finish at the dentin margins.

The effect of wavelength, bandwidth, and probe design and position on assessing the vitality of anterior teeth with laser Doppler flowmetry.

OBJECTIVES: To investigate the effect of four variables: wavelength (633 nm and 780 nm), bandwidth filter (3 kHz, 15 kHz, 22 kHz), probe fibre separation (250 microns) and 500 microns) and distance of the probe from the gingival margin (2-3 mm and 4-5 mm) when assessing the vitality of anterior teeth with a laser Doppler flowmetry system. DESIGN: Split-mouth cohort clinical trial. SETTING: Childrens dental clinic, Glasgow Dental Hospital and School. SAMPLE AND METHODS: Sample included 11 non-vital maxillary incisors with necrotic pulps in 10 patients (mean age 12.25 years old). Recordings were taken from the non-vital tooth and from a vital maxillary incisor from the same patient, using all 24 combinations of the recording variables listed above. The vital/non-vital ratios of the signals from the 11 pairs of teeth were calculated and discriminant analysis applied to the data. RESULTS: Of the variables investigated, the combination of a 633 nm laser source with a 3 kHz bandwidth filter using a probe with a 500 microns fibre separation placed 2-3 mm from the gingival margin was the most reliable, with 10 out of a possible 11 true positives for pulpal necrosis, no false positives, and one equivocal diagnosis, and was the only combination that recorded a smaller blood flow from the non-vital tooth compared with the vital control tooth for all 11 pairs of teeth investigated. CONCLUSIONS: It was concluded, therefore, that laser Doppler flowmetry can be of use in assessing the vitality of anterior teeth and that this is the preferred combination of recording variables for further investigations.