After a short explanation of the word value, the (cultural) value of teeth, the economic evaluation of dentistry and the payment criteria are being presented. The specific situation of health care as a service which deviates in quite a few aspects from the standard demand-supply model is being pointed out. Attention is drawn to key characteristics of the liberal professions such as the obligation to perform to the best of one's ability, not to a specific result. Function classification appears to offer possibilities for cataloguing the wide variation in practice settings. The well-known wage calculation of Professor De Lembre is being reviewed. Subsequently the analysis of cost variation and induced demand by extra services and profile shaping is being elaborated. Cost-benefit-analysis is the concluding item.
The calcifying epithelial odontogenic tumor was first described as an entity by Danish pathologist Jens Pindborg in 1955. It is an uncommon and locally invasive benign odontogenic tumor. The most characteristic findings are the presence of amyloid-like substance and calcified concentric liesegang rings.
BACKGROUND:The rising number of dental implants placed in the treatment of partial or full edentulism confronts the clinician with more implant-related pathology. The presence of a transmucosal component resembles the natural tooth and makes it likewise prone to oral plaque adhesion and plaque-related diseases. However, non-plaque-related diseases can also occur around implants.CASE:This clinical case describes the historical background, the diagnosis, treatment and follow-up of a 33-year-old female patient presenting with a peripheral giant cell granuloma surrounding a maxillary implant. Diagnosis was established by histopathologic analysis. The treatment consisted of complete excision and bone curettage, strict plaque-control and intensive aftercare. Eight months later, no recurrence had been observed. Nevertheless, the soft tissues did not return exactly to their original situation.CONCLUSIONS:Early diagnosis by means of a biopsy is crucial when an epulis is detected. This results in both a less invasive excision and a more favorable aesthetic outcome.
After describing the socio-economic background of the 18th and early 19th centuries, this article explains the parliamentary initiatives undertaken by the newly-independent Belgian state. The Industrial Accidents Act was passed in 1903, together with other social legislation and created a new area of law, separate from the civil law. In the course of the 20th century repeated additions were made to this law, including, in 1967, the transformation of the original contingency budget into a Fund for Industrial Accidents. The author then goes on to discuss the Fund's role and duties; how it is financed; and the procedures to be followed in the event of an industrial accident.
Toothpastes remain a frequently used auxilary in oral hygiene. Although some new components have been introduced, the base composition does not differ much between toothpaste types. Concerning toothpastes there is a thin border between cosmetics and drugs and it becomes more and more difficult for oral health care workers to prescribe the right toothpaste for the right patient. Production companies are frequently using commercial advertisements to promote their product. In this way, it's getting more and more difficult for the dentist (and patient) to find the suitable product. This literature review aims to search for scientific evidence for toothpaste components and their clinical use. In this way the review can be used as a compendium for health care workers to make the right choice in prescribing toothpastes. Furthermore all available toothpastes on the Belgian market are listed, following their composition.
In the 19th century, the first electric toothbrush was introduced. As years gone by, the design and brushhead movements have been constantly changing. Companies claim that electric toothbrushes are more efficient than manual toothbrushes. In this literature review, the importance of the different brushhead movements, brushing time and brushing force and their impact on microbiology and gingival recession is pointed out. Furthermore, the efficiency of electric toothbrushes is evaluated through the available scientific evidence.
Canine impaction is a phenomenon enough current in dental practice. It can have more or less complex consequences. The management of impacted canine requires accurate knowledge of its exact position in three-dimensional space. Indeed, authors report very different locations (palatal position between 50 and 85%). At our disposal clinical means and conventional and digital radiological investigations each have their own advantages and disadvantages. With the multitude of ways of localization, practitioners must be able to prescribe the most "targeted" investigation ever. This is prerequisite for any successful orthodontic therapy and/or surgery. This work intends to review different clinical and radiographic investigations available and discuss their relevance in terms of location accuracy of the impacted canine.
In recent days mouthrinses became a more and more popular tool in the oral hygiene regime. Different manufacturers commercialize their products in the grey area between cosmetics and medicine. However, one must realize that these products must be used within the limitations of their potential. The aim of this article is to present a complete overview of mouthrinses--and their active components--available on the Belgian market based on the recent literature. The focus is placed mainly on their antibacterial capacity, but also other indications such as anticariogenic activity, halitosis management, hypersensitivity management, anti-mucositis and anti-erosive actions are discussed.
On the last European Workshop for Periodontology, it was accepted that the prevalence of periodontitis in certain regions of Europe and USA has decreased. It remains difficult to phrase a decision concerning the prevalence of periodontitis in general. This article wants to highlight the need of a good oral hygiene and different forms of prevention (primary, secondary & tertiary) in the maintenance of a healthy periodontium. The relationship between gingivitis and tooth loss is pointed out. The prevention is described in the complexity of the periodontitis proces and it's modifying factors. When dealing with different forms of periodontitis (refractory, necrotising gingivitis and periodontitis, agressive periodontitis) prevention needs to be adjusted to the etiology and specific situation. This is also the case in peri-implantitis. This article tends to find a scientific background for oral hygiene and prevention in periodontal disease.
The outcome of oral implant treatment is in part focused on the obtained implant stability as outlined in the success criteria as propose by Albrektsson T. & Albrektsson B. (1987) and by Buser et al. (1997). In those criteria, clinical diagnostic testing of implant stability is a rather crude and subjective procedure. Quantitative measurement technology, such as the Periotest and the Osstell Mentor devices do provide more refined and objective tools to diagnose and monitor the state of osseointegration. On the other hand, their power to predict treatment outcome is rather low.
An early determination of pulpal vitality is crucial with respect to a correct differential diagnosis of revascularisation or necrosis and its treatment. The use of sensibility tests (cold, heat, electrical pulp test) in combination with X-ray are commonly promoted. However these tests are arbitrary, based on sensations and therefore not always reliable. In such situation the registration of 'real' pulpal blood flow and hence pulp vitality will be more than an added value. The most studied and well documented method is laser Doppler flowmetry (LDF) as it is non invasive, direct and objective. In this article we describe blood flow, LDF and its characteristics, advantages and disadvantages of this method and the newest developments regarding LDF. Despite a low implementation of LDF in Belgium, this technique proved to belong indisputable to the basic assets of a dental clinic. A number of cases are described to demonstrate the efficacy and added value of LDF in assessing tooth vitality.
The most important constituent of the bleaching process is the hydrogen peroxyde. The bleaching effect is the result of a change in the chemical structure of organic molecules in the teeth. Different bleaching techniques are described on the basis of the concentration of the hydrogen peroxyde used and on the basis of the different methods of application. It has been demonstrated that a faster change in colour can be obtained when bleaching is performed in combination with a light source i.e. power bleaching aiming for a more in depth change of colour. Different investigations have demonstrated that negative effects associated with bleaching agents are seen earlier when light sources have been used as accelerators. So, light activation may not lead to 'heating of the pulp'. Different types of laser bleaching have been described, though, not all of them will lead to the desired result. There is only one exception at present and this is the KTP-laser bleaching with the Smart Bleach gel. The specific laser-tissue interaction is the result of different activation processes of the hydrogen peroxyde in the gel: as a result of the interaction with the laser a photocatalytic effect is induced (i.e. the activation of the gel by means of light--this is also referred to as a photochemical reaction), a limited photothermal effect (light absorption may result in a certain heating of the gel). The light activated gel also has an alkaline pH, which favours the ionisation of the hydrogen peroxyde into perhydroxyl ions (these are the most reactive free radicals). It is also possible to directly cut the tetracycline molecules (a good absorption of light by the tetracycline molecules at 532 nm). This will result in better decolouration of tetracycline stained teeth. This last process is described as direct photobleaching. It also needs to be emphasized that bleaching with a laser can only be performed by a dentist who has acquired a substantial knowledge on laser-tissue interaction and laser physics, and who follows accurately the requested bleaching procedure. Furthermore, whatever the opinion might be, tooth bleaching is a medical dental procedure on biologic tissues and hence this procedure can only by dentists.
UNLABELLED:The aim of our study is to evaluate the efficiency of the Nd:YAG laser in association with graphite for the treatment of dentinal hypersensitivity. 20 patients suffering of different degrees of this affection were involved. The treatment protocol was: cleaning and drying of the dentinal surfaces, evaluation of the level of pain using a graduated scale (after use of an air spray during 3 sec at a distance of 1 cm from the dentinal surfaces), the treated area was smeared with a graphite paste (graphite mixed to physiologic solution), then irradiated with the Nd:YAG laser until complete removal of the graphite (VSP Mode of 140 microsec, 0,25W, 10 Hz, 300 microm diameter fiber, fluence: 35.39 J/cm2), rinsing and drying followed by a second smearing with the graphite, second lasing, rinsing, drying and a new evaluation of the pain immediately after the treatment and one week later.RESULTS:The means and standard deviations of the level of pain were 7.34 +/- 0.86 before treatment, 3.24 +/- 1.18 immediately after and 2.07 +/- 0.73 one week after. No anesthetic aspect was noticed after treatment. To conclude, our result revealed significant and immediate pain reduction with respect of aesthetics and the natural aspect of the treated teeth. Our protocol is a promising alternative to the treatment of dentinal hypersensitivity.
Vestibular deepening for maxillary edentulous patients is mainly indicated once instability cannot be reached due to important bone resorption. Vestibular deepening with CO2 super-pulsed laser enhance, in a bloodless environment, sustentation as well retention of those full dentures in good operative conditions as compared with conventional techniques.
In 1999, the Haute Autorité de Santé (HAS) issued recommendations on the follow-up in France of diabetic patients. It recommends at least an annual dental examination with special attention on the periodontal environment. The results of studies suggest that recommendations on the monitoring of oral diabetes are few or not implemented. In this work, we sought to evaluate the application of the recommendations of the HAS for patients with diabetes and in particular the recommendations on oral follow-up, from a cross-sectional survey using questionnaires to dentists (CD), general practitioners (MG) and diabetic patients in the region of Pays de la Loire. The results of this cross-sectional study shows that the requirements for monitoring oral health of these patients are poorly known and therefore far from being massively applied by health professionals. Our study revealed a lack of knowledge among health professionals, in monitoring oral diabetic patients. The causal association between diabetes and periodontal diseases are now well established; the dentist should be more involved in the medical team during the monitoring of diabetic patients. His role involves the prevention and care oral disease early. The patient information is the first step of prevention and care that it should be issued in any consultation with a dentist and relayed by the associations of diabetic's patients who should also be better informed.
Laser treatment in promoting dental care is present in many areas and disciplines. Modern practice management implies also the introduction of new technology. As there is evidence of the added value for lasers in different disciplines in dentistry practitioners should not be hold back and not wait for patients demanding for this technology for dental treatment.
Since their appearance in 1960, lasers have been considered useful light sources for medical applications. Laser light is monochromatic, the bundle is parallel and can be directed and focussed, as a result of which very high energy densities can be achieved. Several applications in dentistry have been investigated over the past decades. This article describes the physics behind lasers, the characteristics of the laser beam and overviews the laser wavelengths currently used in dentistry. The different interactions between the laser beam and the target are explained.
Many lasers (i.e., different wavelengths) are available today for clinical applications. Not all lasers are to be used for cavity preparation and removal of carious tissues. Erbiumlasers (Er:YAG and Er,Cr:YSGG) are suitable for these purposes (the wavelengths coincide with the highest absorption peaks of water and hydroxyapatite). The advantages during cavity preparation and caries removal are smear layer free cavity walls, selective and localised removal of tooth substance, a restricted need or the absence of anaesthesia, and cavity walls with a higher acid resistance resulting in a better protection against secondary decay. Possible side effects of erbium lasers with water cooling and used with respect for correct power setting are minimal and can be compared with those of rotary instruments. Erbium laser tooth preparation is now one of the options in the minimal invasive approach. The needs for acid etching has been debated for long. At present it has become clear that acid etching is mandatory to obtain a good adhesion and retention with resin composites.
