Odontogenic infections continue to be the most common reason for people to seek dental care. Antibiotic therapy, combined with appropriate surgical intervention has been the mainstay in treating dental infections for many years. Availability of new antimicrobial agents and reports of decreased efficacy in commonly used antibiotics warrant continued study to assure that the most effective agents are utilized. This paper presents a brief summary of the bacterial populations associated with odontogenic infection and their antibiotic resistance mechanisms. Information from a number of studies, including our own data, concerning antibiotic resistance and efficacy are presented. This paper may provide the practitioner with additional information as a guide for appropriate antibiotic use in odontogenic infections.
OBJECTIVE:To document the evolving economies of dental establishments in the State of Tennessee during a period of significant growth of the number of establishments before and after the "Great Recession."METHOD:Published results from the five-year economic surveys by the U.S. Census Bureau on business receipts and salaries of employees (including dentists) for the State of Tennessee and its counties were used to construct a review of these developments.RESULTS:Between 2007 and 2012, there were continued increases in average current dollar business receipts and employee salaries. However, in terms of standard dollars, removing the effects of inflation: 1) business receipts increased in 19 counties but decreased in 37 counties; 2) employee salaries increased in 13 counties but decreased in 30 counties.CONCLUSIONS:Results are in line with the reports by the ADA Health Policy Institute, which indicate that nationally the percentage of dentists who report they are not busy enough has increased and dentists' earnings are stagnating. The need is to expand the delivery of care to underserved populations, including the poor, individuals with disabilities, minorities and new immigrant populations, for whom oral health services may not be a priority commodity.
The success of composite restorations requires meticulous clinical technique in addition to reliable restorative materials and armamentarium. Early failure of restorations is undesirable and are usually replaced at no cost to patients. A metaanalysis study reported a mean annual failure rate of 1.46% for posterior composite restorations. At the University of Tennessee Health Science Center College of Dentistry (UTHSC CoD) predoctoral clinic the percentage of posterior composite restorations replaced within 12 months, retrieved from 2007-2014 electronic chart 'redo' records, was on average 0.58%. Several factors may have contributed to the quality of composite restorations placed by novice clinicians with modest experience. Student doctors are educated about composite placement in preclinical courses and then work under close supervision during their clinical training. This article describes restorative techniques for composites and the rationales taught at the UTHSC CoD Department of Restorative Dentistry. The objective is to share the information, which can be adopted or modified by general practitioners in daily practice.
The use of an erbium laser to treat carious teeth has proven to have several advantages when compared to rotary instruments. The clinician is able to remove a minimal amount of tooth structure, thus minimizing the risk of pulpal exposure. The extremely short pulses of erbium lasers combined with an aerosolized water spray have been shown to cool the pulp as opposed to rotary instruments which may create heat that could lead to a pulpitis. Bonding to the lased surfaces is improved because the smear layer is removed, bleeding is controlled, and the lased tooth surface appears etched with open dentinal tubules. The laser also provides a bactericidal effect and the need for local anesthetics is eliminated or reduced. The use of the erbium laser to prepare cavity preparations can be done as quickly, or oftentimes more quickly, than using a rotary instruments. In addition, patients appreciate the absence of the high speed drill noise and vibration.
This is the first in a series of commentaries related to admission to The University of Tennessee College of Dentistry. Admission to dental school in the current climate is exceedingly competitive-much more so than at any time in history. The purpose of the paper is to examine over thirty-five years of class size and total applications to the University of Tennessee College of Dentistry to gauge competition for admission today versus any time in the past thirty-five years.
Upon the premature loss of permanent anterior teeth from unanticipated trauma or by ongoing patient neglect requiring surgery, patient requisites of functional and esthetic considerations must be addressed. Interim management can be achieved through the use of several diverse fixed and/or removable treatment modalities. The purposes of this report are to provide a review of traditional and unconventional techniques for interim replacement of missing anterior teeth and to present a clinical report demonstrating the fabrication of a removable, thermoplastic (vacuum-formed) EssixTM prosthesis, utilizing composite resin as the surrogate material of choice for the absent teeth. This measure proved to be an immediate, esthetic, and transitional treatment solution prior to a permanent resolution for the patient's long-term dental requirements.
There have been significant advancements in regenerative dentistry demonstrated in large animal studies, particularly in the areas of endodontics and periodontics. By using dental stem cells, pulp tissues can be regenerated in empty root canal space, and periodontal pockets can be regenerated to its normal state. To further test its clinical applications and perhaps to provide such patient care service if proven safe and successful, a facility called good manufacturing practice where stem cells are processed is needed. However, such facilities are rare.
OBJECTIVE:The evaluation of hard and soft tissue relationships is an important part of the study of facial morphology, craniofacial development and orthodontic treatment and outcomes. Historically, this evaluation has occurred in two dimensions. The purpose of this study was to develop a protocol to study the relationships of hard and soft tissues in three dimensions without the use of additional radiation.MATERIALS AND METHODS:Stereo photogrammetric images created by the 3dMDTM Face system and models digitized using the Motion View scanner were utilized. Using a previous lateral cephalometric image from the orthodontic records appointment, these hard tissue and soft tissue images were integrated.RESULTS:The integration of all data sets was accomplished with an average error rate of less than .05mm. A method was developed, thus allowing measurement of soft tissue thicknesses and changes over treatment time in relation to the underlying dentition.CONCLUSIONS:Evaluation of hard and soft tissue relationship in three dimensions can be accomplished without the use of additional radiographic studies.
This case reports the concurrence of gemination and fusion affecting the maxillary central incisors of a twelve-year-old patient and the collaboration of the pediatric dentist, endodontist, orthodontist and oral and maxillofacial surgeon. Developmental dental anomalies can occur in both primary and permanent dentitions as a result of conjoining defects. Double teeth, or cases of gemination or fusion, are not exceedingly rare, but the presence of both anomalies in a single patient is a rarity. Gemination is the division of a single tooth bud, resulting in a large single tooth with a bifid crown and common root and root canal. Fusion is the union of two separate tooth buds, resulting in a joined tooth with confluence of dentin and separate root canals. Labial apexogenesis with MTA, composite resin placement, re-contouring and orthodontic care allowed proper alignment with long-term monitoring of growth and development for possible incisor replacement.
Applying the biomimetic principles, maximum preservation of the sound tooth structure may be achieved by means of adhesive restorations. Due to bonding, it is possible to conduct minimally invasive esthetic procedures with laminate veneers assuring a high mechanical resistance of the tooth/restoration bond. A clinical case of adhesive restorations is presented using the bonding protocol respecting the diversity of each product's commercial brands and manufacturer's recommendations.
Restorative dentistry is experiencing a significant shift towards a rising usage of tougher all-ceramic materials. This trend must be incorporated into existing fixed prosthodontics academic curricula through the integration of lithium disilicate and zirconium oxide crown preparation guidelines. In addition, crown fabrication techniques have also evolved for these newer materials through digitization of preparations and impressions and their computer-assisted manufacturing. This article reviews current crown preparation and cementation guidelines while describing the teaching program in fixed prosthodontics at the University of Tennessee Health Sciences College of Dentistry.
Controversy remains in understanding both the development and treatment for the odontogenic keratocyst (OKC). With recent changes in nomenclature recognizing the odontogenic keratocyst as a benign tumor, the debate over the proper course of treatment to limit recurrence and morbidity will continue. This study presents two cases where conservative treatment failed to prevent recurrence and each patient underwent resection of aggressive, multicystic OKCs to provide the best chance for definitive care without recurrence and limited morbidity.
Matriculation from the pre-clinical setting to the clinical environment is a tremendous accomplishment and exemplifies the student's perseverance in learning the fundamental concepts necessary for success in the clinical application of dentistry. In an effort to maximize its educational philosophy for the teaching program, the University of Tennessee's College of Dentistry has implemented Introduction to Clinical Practice I and II within the dental curriculum. Introduction to Clinical Practice I and II are designed to help the dental students effectively and smoothly transition to the clinical setting from the classroom and pre-clinical setting. This article describes the university's efforts and continuous improvements within the pre-clinical dental curriculum for advancing students to the clinics. The purpose of this article is to provide helpful information to other dental educational institutions on how to assist their pre-clinical dental students in transitioning to clinical student-doctors.
OBJECTIVES:To quantify the depth of cure (DOC) of a composite resin system using two different testing criteria.METHOD AND MATERIALS:The DOC testing employed two different experimental protocol: 1) Forty-eight previously extracted human molars were randomly assigned to four groups of twelve each (n = 12): Group 1 SonicFill composite resin system, shade A1; Group 2 SonicFill, shade A3; Group 3 Herculite Ultra composite resin, shade A1; Group 4 Herculite Ultra, shade A3. Cylindrical cavities (4.0 mm diameter and 10 mm depth) were prepared at the tooth CEJ, in a mesiodistal direction. The preparations were filled with each composite resin material in one bulk increment and polymerized with a LED light for 20 seconds. After 5 minutes, the occlusal surfaces of the teeth (specimens) were ground flat until the composite was exposed in a transverse plane. The uncured (soft) composite was scraped away, using a "modified" ISO 4049 DOC specification, and the remaining cured (hard) material was measured. Three measurements, at different positions of the specimen, were performed, for a total of thirty-six measurements per specimen group. The measurements were averaged and divided by fifty percent, arriving at the final DOC for each specimen. 2) A DOC testing protocol was performed using a two-piece (4.0 mm x 10.0 mm) custom-made Teflon device (mold). The groupings duplicated the previous experimental protocol. The mold was filled with each composite resin material in one bulk increment to a 10 mm length (depth). Excess composite material was removed, followed by placement of a Mylar strip over the external orifice. The composite resin specimen was light-polymerized for 20 seconds. Again, the uncured (soft) composite was scraped away, with the same measurement protocol followed as in method 1. Statistical analyses were conducted using ANOVA tests at a p < .05 level of significance.RESULTS:Statistical differences were exhibited between the two different DOC methodologies, extracted teeth versus the Teflon device. Considering each method, the SonicFilTM composite revealed significantly greater DOC compared to the Herculite Ultra composite resin. Also, significant differences were displayed between the Al compared to the A3 shades, with the A1 (lighter) shades exhibiting greater DOC.CONCLUSION:The prepped teeth seemed a more realistic DOC testing approach due to the variables of light interaction of the composite resin to either tooth substance (enamel/dentin) versus using the Tefion mold, although greater DOCs were recorded using the manufactured device. The SonicFill composite system did reveal greater DOC compared to the Herculite Ultra composite regardless of experimental method or material shade.
AIM:To illustrate the reversibility of "pathologic tooth migration" in several patients that were managed by periodontal therapy alone, along with a review of the relevant literature.BACKGROUND:Pathologic tooth migration (PTM) is a common phenomenon among patients seeking dental care. Different etiologic factors have been implicated in PTM: loss of periodontal support, occlusal interferences, posterior bite collapse, and various oral habits such as: lip biting, tongue thrusting, and playing wind instruments. Identification of all the causative factors involved in PTM is crucial for a successful treatment outcome. Managing severe cases of acquired diastemata may necessitate a complex and a sequential intervention involving periodontic, orthodontic and prosthodontic measures. However, "spontaneous regression" of teeth to their original position may occur in certain cases after elimination of the offending factors.CONCLUSION:"Spontaneous" closure of acquired diastemata could occur following surgical and/or non-surgical periodontal therapy or removal of occlusal interferences. Correction of pathologically migrated teeth without orthodontic or restorative treatment is feasible, but unpredictable.
The overall health of the United States' (U.S.) population has been surveyed and reported for several decades in a quest by healthcare professionals to understand the etiology for healthcare disparities and seek to lessen its effects on individuals and, ultimately, eliminate them. Many of these surveys and reports have illuminated disparities, of access to healthcare by focusing on measures to address health literacy deficiencies. A plethora of information concerning patients' health literacy skills and printed information has been made available for dentists and their staff. The printed information is in the format of published patient- centered educational guidelines and readable dental and medical limited reach media (LRM), such as information sheets and prescription drug leaflets. LRM has great potential to enhance access to healthcare information for the reader of interest--your patient--at a readable and comprehensible level. Printed materials are an effective means to enhance health promotion and education for the lay populace. Tailored LRM protocol and the Patient Introduction Form (PIF) are excellent educational instruments for dentists and the dental/medical team (The Team). These instruments are valuable assets for The Team to assist its patients in monitoring and maintaining dental and medical adherence protocols in their daily lives.
The need for partial removable dental prostheses (PRDP) is increasing as the over-65 partially edentulous population grows. The use of flexible materials in the fabrication of these prostheses has captured a large portion of the market once occupied by traditional cast metal PRDPs. While there are some clinical advantages to the use of flexible PRDPs, there are also disadvantages and contraindications that must be considered. This paper describes a clinical case in which a patient's dentition is restored with a hybrid partial removable dental prosthesis consisting of a traditional metal framework and flexible denture base and clasps. This design can result in achieving the benefits of each type of prosthesis in an effort to satisfy the needs of the patient.
Dental education is an ever evolving process due to continual advancements in patient treatment. This article provides the reader with a look into an educational process that affords the student with better clinical experience without an increase in clinical training hours. When a comprehensive care model of education is introduced into a traditional care setting, the comparison of procedures completed with the previous 5 years results indicate an increase in the number of amalgam and composite restorations placed of 26% and an increase in crowns placed of 32.9%. Integration of the dental hygiene program and additional remote sites afford new populations of patients where clinical skills can be developed which will result in a graduate more able to go directly into private practice.
