HPV-Related Oral Cancer Screening: Different Presentation, Different Protocol
Dental professionals, making assumptions about the two distinct pathways of oral cancer, often forgo comprehensive oral cancer screenings, which affects patients’ prognoses and creates malpractice liability. Absent comprehensive screenings, HPV-related oral cancer is diagnosed late-stage, when morbidity is highest. To curb late diagnosis, we must heed current research. HPV-related oral cancer, which is rapidly on the rise, is different in its clinical presentation from tobacco/alcohol-related oral cancer. Thus, we cannot rely on what we learned in dental school, risk profiling, or traditional tools to screen for HPV-related oral cancer. We must change our approach, by implementing comprehensive screenings that incorporate extraoral/intraoral tactile screenings, visual screenings of all tissues, and asking appropriate, revealing questions.
Water Line Contamination in the Dental Office
Dental unit water systems (DUWS) harbor bacterial biofilms, which are known reservoirs for pathogens.1
In 1995, the ADA Council on Scientific Affairs responded to scientific evidence that suggested the microbiologic quality of water used in dental treatment required improvement.2 A call to action was taken on the design of dental equipment. By the year 2000, water used during nonsurgical dental procedures consistently contained no more than 200 colony-forming units per milliliter (CFU/mL) of aerobic mesophilic heterotrophic bacteria in the unfiltered output of the dental unit. A heterotroph is “an organism that cannot fix carbon from inorganic sources (such as carbon dioxide) but uses organic carbon for growth.” https://en.wikipedia.org/wiki/Heterotroph These bacteria are not necessarily harmful, but determining the heterotrophic plate count is used as an indication of the amount of residual disinfectant present in a water supply. Since then, technological advances have made this possible. The Centers for Disease Control and Prevention (CDC) now recommends that “coolant water used in nonsurgical dental procedures meet EPA regulatory standards for drinking water,” which is less than or equal to 500 CFU of heterotrophic bacteria per milliliter of water. This recommendation was published in the CDC’s Guidelines for Infection Control in Dental Health-Care Settings—2003. (Guidelines from the CDC differ about water used in oral surgical procedures.)
Foundations of CBCT Imaging for Implant Planning and Surgical Guides
The use of CBCT imaging has drastically enhanced and changed the way dentists can diagnose and assess patient anatomy in preparation for implant placement. Now, with a single CBCT scan the patient’s entire craniofacial complex can be visualized and viewed from every angle in 3D and any structure can be cross-sectioned into 2D slices for detailed assessments and measurements. Furthermore, virtual implant planning within the CBCT scans can be performed and converted into a physical surgical guide that can be used during surgery. These abilities give the clinician tremendous potential but also create new challenges such as: where to start, what anatomy to look at, how to cross-section the anatomy properly, and what are the protocols and steps for ordering a surgical guide? The purpose of this CE course article is to clarify some of these questions, to provide an organizational framework by which clinicians can approach scans, and to review the terminology, capabilities and protocols of surgical guides.
Anatomy of a Handpiece: Understanding Handpiece Maintenance and Repairs
Today’s clinician is extremely dependent on the handpiece to sustain a smooth-running practice. The handpiece is an incredibly sophisticated device that requires a diligent maintenance protocol to keep it running properly and safely. Routine, repeated heat sterilization has the most adverse effect on the dental handpiece. Perhaps due to this dependency on handpieces, combined with the damage resulting from repeated routine sterilization and the need for consistent maintenance, the handpiece has earned an undeserved reputation for excessive breakdowns. The dental team can keep handpieces functioning smoothly longer, and maximize the return on the significant investment the dentist has made in handpiece technology, through appropriate maintenance procedures. Careful selection from repair options is also required.
Dental Erosion: Etiology, Diagnosis, and Prevention
Dental erosion is a prevalent condition that occurs worldwide. It is the result of exposure of the enamel and dentin to nonbacterial acids of extrinsic and intrinsic origin, whereby mineral loss occurs from the surface of the tooth. The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first molars in adolescents. Characteristic early signs of dental erosion include smooth and flat facets on facial or palatal surfaces, and shallow and localized dimpling on occlusal surfaces. Early intervention is key to effectively preventing erosive tooth wear. Effective prevention of dental erosion includes measures that can avoid or reduce direct contact with acids, increase acid resistance of dental hard tissues, and minimize toothbrushing abrasion.
Management of the Oral Infection Part 2
This is the second of a two-part course on oral infection. It includes the clinical and diagnostic features of infections that clinicians are most likely to encounter: fungal, viral and bacterial. Published clinical recommendations and current scientific literature are reviewed and management strategies are discussed. In addition, scientifically supported alternative therapies are mentioned where applicable. The reader should refer to current pharmacology and dosing information prior to prescribing any antifungal therapy.
Management of the Oral Infection: Part 1
This two-part course will review the management of the acute oral infection. Part one focuses on the essentials that must be considered when treating the dental infection including microbiology, triage, anatomy, and laboratory testing. It includes the surgical, antibiotic, and palliative actions needed in the treatment of the acute dental abscess. Part two will emphasize the treatment of oral infections due to fungal, viral, and bacterial organisms.
Fluoride and Other Preventive Therapies: Maintaining Oral Health at Each Stage of Life
Fluoride and other preventive therapies have been used worldwide to combat caries and aid in plaque reduction. Dental professionals should employ current evidence-based research and clinical guidelines when choosing the appropriate method for using medicaments for intraoral disease prevention. When choosing an appropriate regimen, it is important to consider the patient’s risk level, dental status, compliance, and preferences.
Dental Handpiece Maintenance and Repair
Dental handpieces have evolved greatly over the years, and they remain a vital part of dentistry today. The care and maintenance of these instruments are essential to preserving not only the lifespan of these instruments but their proper function as well. While traditional air-driven handpieces are still a mainstay in dentistry, electric handpieces are now being more widely used. The newest technology takes components from both electric and air-driven handpieces. Understanding how to clean and maintain handpieces and their components properly will help the clinician achieve optimal results. Knowing when to replace or rebuild handpiece turbines and who to send the handpiece to for repairs, is essential for handpiece performance and turnaround times.