Hepatitis: still a concern?

Although some forms of viral hepatitis were identified more than 50 years ago, hepatitis continues to have an impact on the practice of dentistry. Possible transmission in the dental setting, management of the chronically ill, and legal issues related to treatment of infectious patients combine to emphasize that hepatitis is still an important issue for dental health care workers. Currently, 7 viral forms are recognized. Those with predominantly enteral modes of transmission--including HAV, HEV, and HFV--are of minor concern in the dental environment. HBV, the most infectious blood-borne pathogen, has been largely controlled in this country by vaccination and the use of universal precautions. HDV is an incomplete virus that has HBV infection as a prerequisite. HCV is of great concern today for several reasons. A high percentage of HCV infections results in chronic disease. Most cases remain asymptomatic for an extended period of time, and many have no identifiable risk factors. Currently, no vaccination is available for HCV. Patients infected with HCV present a management challenge, because they may ultimately develop serious liver dysfunction. In fact, HCV infection is presently the most common reason for liver transplantation. By understanding the various forms of viral hepatitis and following recommended infection control and vaccination protocols, the dental healthcare worker can treat infected patients in a manner that is safe for both patients and dental health care workers.

Infectious diseases and the dental office.

Dentists and other health care workers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. In recent years there has also been widespread concern among the general public. Many infectious diseases, including HIV, hepatitis, tuberculosis and syphilis, are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. A knowledge of these diseases will allow the practitioner to recognize associated lesions and also to take appropriate steps to minimize the risk of transmission in the dental office.

Self-inflicted oral trauma: report of case.

Self-inflicted oral trauma is often encountered in patients who lack cerebral control over the masticatory cycle. Many factors must be considered in treatment, and a variety of appliances may be fabricated to prevent injury to oral structures. This case report documents the use of a soft acrylic appliance in treatment of a comatose patient who showed ruminatory reflex chewing.

The dentist-patient relationship: perceived dentist behaviors that reduce patient anxiety and increase satisfaction.

This study relates perceived dentist behaviors to anxiety reduction in patients during treatment, and to satisfaction with the dental visit. The sample consisted of 250 adult patients, 110 men and 140 women, at two outpatient hospital dental clinics. Immediately after treatment, patients were asked to respond to a list of 25 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained by patients were self-ratings of anxiety during treatment and satisfaction measures from the DVSS. Ten behaviors were significantly associated with anxiety reduction. A stepwise multiple regression analysis with anxiety reduction as the dependent variable indicated that to the patient, the dentist's explicit dedication to prevent pain was the most important dentist behavior, with friendliness, working quickly, being calm, and giving moral support, being important auxiliary behaviors. Most of the 25 dentist behaviors studied were associated with patient satisfaction. A stepwise multiple regression analysis indicated that the dentist's empathy and communicativeness were among important correlates of patient satisfaction. An experimental approach to causal analysis of anxiety reducing behaviors needs to be studied.

Validity and reliability of the interval scale of anxiety response.

The Interval Scale of Anxiety Response (ISAR) is shown to be a valid and reliable instrument for measuring situation dental anxiety in adults. The ISAR demonstrates differences that are known or expected between various population subgroups. Thus, significantly higher scores, indicating greater levels of anxiety, are reported by women compared with men; by hospital clinic patients compared with private practice patients; by occasional compared with regular users of dental care; by those with lower educational levels; and by those patients undergoing exodontia compared with patients having other dental procedures. Younger adults also report significantly higher anxiety scores during treatment than older adults. The ISAR is also significantly associated with other measures of anxiety and pain, and with a measure of dentistrated difficulty of extraction. Reliability is assessed favorably and present-time administration is found to improve ISAR accuracy over its retrospective use.

The effects of alcohol and cetylpyridinium chloride on the buccal mucosa of the hamster.

The effects of alcohol and cetylpyridinium chloride on normal and abraded hamster buccal pouches were studied in 23 study and 23 control animals over 21 consecutive days. No significant differences were found between the control and study animals, both groups having normal cheek pouch mucosa at the end of the study period.