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To investigate the effectiveness of two home bleaching modalities on whitening of tetracycline-stained teeth (TST).A randomized controlled trial on the bleaching effect of 15% carbamide peroxide gel loaded in tray and 6.5% hydrogen peroxide strip in subjects with TST was performed. Eligible subjects were judged independently by two assessors, and randomly assigned into the tray or the strip group. Lightness (L*), redness (a*) and yellowness (b*) were measured with colorimeter at baseline, one, two and three months. Any adverse reaction associated with bleaching were also recorded. Overall colour changes (ΔE) were analysed by one-sample and independent t-test/Wilcoxon test at significance level α=0.05.Twelve and fourteen participants were allocated to the tray and the strip group respectively. Both groups experienced noticeable and significant L*a*b* improvement at the end of the trial in comparison to the baseline (p0.05). Significant improvement was observed in the first month for the tray group (p0.05) and in the first two months for the strip group (p0.05). While greater lightness improvement was observed in the tray group over the strip group in the first month (p=0.02), the reverse was noticed in the second month (p=0.01). There was no difference between two groups at the end of this trial (p0.05) and no significant adverse reactions were observed.Over a three-month period, 6.0% hydrogen peroxide strip performed equally well as the 15% carbamide peroxide tray delivery system in TST.Home bleaching systems produce noticeable tooth whitening effect in subjects with tetracycline-stained teeth.

For centuries only three professions were recognised as such: medicine, law and theology. Now that the word 'professional' is applied to all occupations it can be difficult to understand the meaning of professionalism within dentistry and healthcare. We simply cannot treat dentistry as a commodity or business when it is a highly specialised personal service. Now more than ever, dentistry is a team game and all dental professionals must maintain the values and codes that distinguish what we do from most other vocations.

Background Appendicectomy for acute appendicitis in children may be performed in specialist centres by paediatric surgeons or in general surgery units. Service provision and outcome of appendicectomy in children may differ between such units. Methods This multicentre observational study included all children (aged less than 16 years) who had an appendicectomy at either a paediatric surgery unit or general surgery unit. The primary outcome was normal appendicectomy rate (NAR). Secondary outcomes included 30-day adverse events, use of ultrasound imaging and laparoscopy, and consultant involvement in procedures. Results Appendicectomies performed in 19 paediatric surgery units (242 children) and 54 general surgery units (461 children) were included. Children treated in paediatric surgery units were younger and more likely to have a preoperative ultrasound examination, a laparoscopic procedure, a consultant present at the procedure, and histologically advanced appendicitis than children treated in general surgery units. The unadjusted NAR was significantly lower in paediatric surgery units (odds ratio (OR) 0·37, 95 per cent confidence interval 0·23 to 0·59; P < 0·001), and the difference persisted after adjusting for age, sex and use of preoperative ultrasound imaging (OR 0·34, 0·21 to 0·57; P < 0·001). Female sex and preoperative ultrasonography, but not age, were significantly associated with normal appendicectomy in general surgery units but not in paediatric surgery units in this adjusted model. The unadjusted 30-day adverse event rate was higher in paediatric surgery units than in general surgery units (OR 1·90, 1·18 to 3·06; P = 0·011). When adjusted for case mix and consultant presence at surgery, no statistically significant relationship between centre type and 30-day adverse event rate existed (OR 1·59, 0·93 to 2·73; P = 0·091). Conclusion The NAR in general surgery units was over twice that in paediatric surgery units. Despite a more severe case mix, paediatric surgery units had a similar 30-day adverse event rate to general surgery units. Service provision differs between paediatric and general surgery units.

A good manageable treatment plan does not just happen, but comes about as the natural consequence of taking carefully considered steps. History taking and clinical examination are two of the most important aspects of the patient assessment process, and complement each other to such an extent that it is impossible to build a satisfactory treatment plan without combining and collating information from the two procedures.

Surveillance of trends in cancer management can help in service evaluation and quality improvement.We used East Anglia cancer registration data from 1995-2006 on 3063 patients with epithelial ovarian cancer. We described treatment patterns and examined their predictors using multivariate logistic regression.Use of chemotherapy (with/without surgery) and of surgery (with/without chemotherapy) remained stable over time (59% and 69% of patients, respectively). Use of surgery was less frequent in most deprived compared with most affluent patients (64% vs. 73% respectively; adjusted per increasing deprivation group quintile OR = 0.88, p = 0.001). Among patients treated by surgery, use of omentectomy and of exenteration increased over time (37% in 1995-8 vs. 56% in 2003-6 for omentectomy, and 2% vs. 8% for exenteration respectively, p0.001 for both). More deprived patients were less likely to be treated with omentectomy [42% vs. 53% for most deprived and more affluent patients respectively (adjusted OR = 0.91, p = 0.017)].Socioeconomic differences in use of ovarian cancer surgery require further elucidation. Use of some types of surgery increased over time, potentially reflecting changes in service organisation. The findings provide a 'benchmark' for future treatment pattern surveillance, and regional or international comparisons.

For many years, dental technicians were largely self-regulated and left to work without any undue interference from, or legislation by, outside authorities. This situation has changed somewhat dramatically in recent years, primarily as a result of a) mandatory General Dental Council (GDC) registration of UK-based dental technicians and b) the requirement to comply with certain EC directives governing the provision of dental appliances. There seems to be some confusion, however, about these various changes and the ensuing ramifications for dental practitioners. The purpose of this paper is firstly to clarify the various regulatory issues currently surrounding technician registration and the provision of laboratory work ('Made in Britain' or otherwise) and secondly to explore the various internationally-recognised quality assurance standards that can be applied to the production of such work in order to assist dentists in gauging quality-related claims made by dental laboratories, both in the UK and overseas.

Historical returns of coho salmon Oncorhynchus kisutch to the Yakima River basin were estimated to range from 45,000 to 100,000 fish annually but declined to zero by the 1980s after decades of overexploitation of fishery, water, and habitat resources. In 1996, the Yakama Nation and cooperators initiated a project to determine the feasibility of reestablishing a naturally spawning coho salmon population in the Yakima River. The project explored the feasibility of successful coho salmon recolonization in the Yakima River by introducing stocks that had been reared in hatcheries for multiple generations. After 10–20 years of outplanting, we compared data for adult returns of known natural origin (i.e., returns from parents that spawned in the wild) and returns from hatchery releases. We found that fish of natural origin returned at a significantly larger size than those of hatchery origin. The mean egg mass and mean egg size of natural-origin females were greater than those of hatchery-origin females...

Background The authors explore the importance of human values in dental practice, an area often overlooked as we struggle to deal with the everyday demands of treating patients and managing staff members. Such values are, however, fundamental to the success of any practice; therefore, it is important to understand their significance. Conclusions Problems arise in dental practices when gaps develop between the values held by the various players involved (that is, between the entire dental team and patients, the dentist/owner's personal values and business goals, the dentist/owner and staff members, and the dental practice and any third-party funding organizations). Practice Implications By understanding the potentially damaging consequences of value gaps for practice viability, dental practice owners and managers can take steps to create a more harmonious workplace in which all parties strive to reach common goals.

This paper, the third in a series of articles exploring some of the management issues facing dentists today, examines the importance of maintaining a motivated, well-trained and properly rewarded staff team.

This is the second in a series of articles exploring some of the issues facing dentists coming to terms with working in the ‘brave new world’. It examines the complex issues of understanding how pricing works, determining the price of a product or service, communicating this to customers, and understanding how people perceive prices and price changes

Many partially dentate dentitions are now being restored using dental implants; but assessment of endodontically treated teeth adjacent to the proposed implant sites has seldom been reported. Assessment criteria are given for sound- and endodontically compromised teeth to ensure adequate preimplant preventive and restorative treatment and to minimize the chances of failure of dental implants adjacent to these teeth. Cases are used to illustrate pitfalls in the treatment planning process.

This is the final paper of a four part series on the management of worn dentition. The factors affecting the selection of restorative techniques for generalized toothwear, such as pulpal vitality, jaw relationship and occlusal guidance are discussed. The practical steps of oral rehabilitation using fixed prostheses are illustrated with two clinical cases.

This is the second paper in a four-part series detailing the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition. In this paper the management of wear in the anterior dentition is discussed, using three case studies as illustration.

In this, the first of a four-part series on the restorative management of the worn dentition, the aetiological factors, diagnosis of toothwear and preventive measures are summarized. Later papers will deal with the management of localized anterior and posterior toothwear, the use of ‘Dahl type’ appliances as an effective means for the restorations and the various treatment options for the management of the dentition showing generalized wear. The series will discuss the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition.

For many years the 27 bodies corporate registered with the General Dental Council were of little interest to most people in the UK dental profession, serving only as an anachronistic reminder of a bygone period. How times change. Although they still have only a small share of the dental market – with 4% of all dentists in the UK in early 1999 – they have expanded rapidly from a small base and are expected to continue to do so in the future.1 The reasons behind this growth are numerous2 and include such factors as: deregulation of the profession allowing dentists to advertise thus facilitating company branding; a general move away from NHS dentistry; a growing consumerism amongst the general public; precedents set by pharmacists and opticians; and, last but not least, the belief of venture capitalists amongst others that investment in dentistry will yield attractive returns.

Background There has been a resurgence of interest in national Community Health Worker (CHW) programs in low- and middle-income countries (LMICs). A lack of strong research evidence persists, however, about the most efficient and effective strategies to ensure optimal, sustained performance of CHWs at scale. To facilitate learning and research to address this knowledge gap, the authors developed a generic CHW logic model that proposes a theoretical causal pathway to improved performance. The logic model draws upon available research and expert knowledge on CHWs in LMICs. Methods Construction of the model entailed a multi-stage, inductive, two-year process. It began with the planning and implementation of a structured review of the existing research on community and health system support for enhanced CHW performance. It continued with a facilitated discussion of review findings with experts during a two-day consultation. The process culminated with the authors’ review of consultation-generated documentation, additional analysis, and production of multiple iterations of the model. Results The generic CHW logic model posits that optimal CHW performance is a function of high quality CHW programming, which is reinforced, sustained, and brought to scale by robust, high-performing health and community systems, both of which mobilize inputs and put in place processes needed to fully achieve performance objectives. Multiple contextual factors can influence CHW programming, system functioning, and CHW performance. Conclusions The model is a novel contribution to current thinking about CHWs. It places CHW performance at the center of the discussion about CHW programming, recognizes the strengths and limitations of discrete, targeted programs, and is comprehensive, reflecting the current state of both scientific and tacit knowledge about support for improving CHW performance. The model is also a practical tool that offers guidance for continuous learning about what works. Despite the model’s limitations and several challenges in translating the potential for learning into tangible learning, the CHW generic logic model provides a solid basis for exploring and testing a causal pathway to improved performance.

– The aim of this study was to evaluate, in vitro, the EVA material (polyvinylacetate-polyethylene copolymer) most commonly used in the fabrication of mouthguards and thus to help understand mouthguard performance and to improve mouthguard design. The material was tested for tensile strength, elongation, hardness and water absorption using specimens and tests described by the American Society for Testing and Materials Standards. Standard EVA sheets of 1, 2, 3 and 5 mm thickness were prepared. With increase in the thickness of the material, both the ultimate tensile strength and the elongation were decreased. The hardness and water absorption were unaffected. It was concluded that, overall, the thicker 5 mm EVA material was recommended for mouthguards as it displayed the least deformation to load and performed equally as well in the tests as other thicknesses.

The conceptual difference between a competency-based education and an education based upon a conventional dental curriculum is, perhaps, the starting point for the development of new curricula. The two systems are not, in themselves, exclusive. There is common ground to be found, and the concept of combining instruction with competency-based learning experiences is emerging in recent publications. This paper describes a competency-based approach applied to a clinical course in conservative dentistry. The learning outcomes of the fourth-year dental students in the new course were assessed using methods that included continuous clinical assessments, student presentations and peer-group reflective evaluations, patient management reviews, a clinical progress examination, the range and amount of work completed, and a written examination and viva voce. Different weightings were given to various elements of the assessment. A formal student assessment of the course rated it as being satisfactory.

ummary. Objectives. This paper examines the literature dealing with oral–facial injuries received during participation in sport and the possibilities open to athletes for their prevention. In particular, the paper examines five different aspects of this topic: the risk of dental injury while playing sports, the role of the mouthguard in preventing injury, types of athletic mouthguard, implications for patients undergoing orthodontic treatment and behavioural aspects of mouthguard wear. Results. It is clear from this review that participation in a number of sports does carry a considerable risk of sustaining dental injury, not only in the so-called contact sports such as rugby and hockey, but also in less obviously dangerous sports such as basketball. Although some evidence exists to the contrary, the majority of studies have found the mouthguard to be the most effective way of preventing such injuries. It is also clear that the custom-fabricated mouthguard, in particular the pressure-laminated variety, is seen to afford most protection. Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances. The fabrication of mouthguards for these patients is also problematic and the literature covering this is reviewed. As with other preventive measures, mouthguard usage is often less than the dental profession would like; the reasons for this are explored in a small number of studies. Conclusion. While much progress has been made in this area, the profession could do much more to promote the greater use of mouthguards.

Market basket food samples from six Canadian cities collected from 1992 to 1996 were analysed for pesticide residues. One hundred and thirty-six composites were prepared for each city, representing 99% of the Canadian diet. Residues were found most frequently in peanut butter and butter. DDE, malathion and captan occurred most frequently, while the fungicides chlorothalonil, dicloran and captan were present in the highest concentrations. Processed commodities contained fewer residues and at lower concentrations than the raw products. No residues were detected in either milk or soy-based infant formula. Of the infant foods sampled, fruit contained both the greatest number and highest concentrations of pesticides.

–Objectives: Most previous studies have portrayed patient satisfaction as a rather simple outcome based solely on patient perceptions. The goal of this pilot study was to determine if evidence could be found to support the view that patient evaluation is a more complex process better explained by drawing on the theories of ‘disconfirmation of expectations’ and ‘attribution’. Methods: A qualitative methodological approach was chosen with data collection being achieved by means of four focus group interviews comprising a total of 25 participants (16 women and 9 men, mean age 43.8 years, standard deviation of 14.45) representing a wider population of adults (over the age of 18) who had attended for dental treatment within the previous 12 months. Results: Analysis suggests that patient perceptions of dental practice alone do not fully account for the way patients evaluate dentists. Disconfirmation of expectations does take place during the evaluation process. Equally, patients appear to apply the attributional concepts of ‘duty’ and ‘culpability’ to determine either satisfaction or dissatisfaction. Conclusions: A better understanding of patient satisfaction, and the evaluation process that leads to satisfaction, can only be achieved if, in addition to patient perceptions, other antecedent factors such as patient expectations and desires are considered. Disconfirmation and attribution theory do appear to play an important role in this process and warrant further investigation.

The boom in U.S. major league sporting venue construction has forced many cities to face issues related to the provision of such facilities, including the location choice. Recent data show that the suburbanization trend long assumed in the literature has been reversed, with a resurgence in downtown venues. This paper demonstrates the reversal and discusses the reasons behind this recent trend. These include a concomitant trend toward smaller market franchises, increasing corporate sponsorship, deliberate downtown revitalization strategies, and the advantages accruing to owners when different parts of an urban area compete for franchises.

Against a background of growing consumerism, satisfying patients has become a key task for all healthcare providers. This paper reviews current conceptual models of consumer satisfaction, including the one most dominant in the marketing literature--disconfirmation theory.

This work extends the conceptual argument for the use of ellipses to portray activity spaces and offers one example of how the ellipse construct can be used to analyze urban travel characteristics, based on observed trip making behavior and socio-economic variables. A problem in characterizing activity spaces has been in integrating the time and space dimensions into the same analytical framework while maintaining an understandable graphical representation of the space-time geographies envisioned by Hagerstrand and others. The ellipse allows this, as well as providing several quantifiable measures to be used for analyzing and characterizing activity spaces and urban travel behavior. In the current application, analysis of variance is used to analyze the resulting elliptic variables of 653 travelers. The results indicate that home location and household size are important factors in determining activity space characteristics and that the ellipse variables provide a different and useful approach for understanding urban travel behavior.

This study analyzes the extent and pattern of lead contamination along roadways in Trujillo, Venezuela, using traffic counts and soil samples collected in the field. The normalized mean lead level for frontyard samples along major traffic arteries was 200 μgg -1 versus 0 μgg-1 for backyard samples. Furthermore 55%of the frontyard lead levels were hazardous, versus 7% of the backyard samples. This suggests a strong relationship between traffic and soil lead content. However, a relationship between lead level spatial patterns and traffic volume patterns was not established, suggesting that factors beyond traffic volume, such as slope and erosion, play a significant role in contamination patterns.

Stapled J-pouch ileoanal operations were performed in 75 patients (35 men, 40 women; 72 with ulcerative colitis, 3 with familial polyposis) without an ileostomy in 68 (43 taking prednisone, 12 emergent surgery, 8 completion proctectomy with ileostomy takedown). The seven primary ileostomies were due to technical difficulties in two patients and toxic colitis in four patients. No patients were lost to follow-up. Of patients followed for more than 1 month, 96% had perfect daytime control, 86% had no nocturnal accidents, and 73% had no nocturnal spotting. Mucosa between the dentate line and the anastomosis averaged 1.1 +/- 1.0 cm, with the anastomosis at, or below, the dentate line in 16 patients, of whom 14 had excellent continence. Stools in 24 hours averaged 6.9 +/- 0.3, of which 1.8 +/- 0.2 were at night. Stool frequency was unrelated to gender, anastomotic distance from the dentate line, or age; however, patients 50 years of age or older had more problems with nocturnal fecal control than those younger than 50 years of age. Anastomotic leaks (four), cuff abscess (one), pouch leaks (two), and pelvic abscesses (three) were treated with drainage in all patients and ileostomy in five. Pouchitis occurred in 31% of patients and responded to oral antibiotic therapy. Acute complications were fewer, functional pouches greater, stool control better, and overall hospitalization shorter (all p0.01) than those in our 63 patients with a mucosectomy and handsewn ileoanal anastomosis.

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding greater than or equal to 50 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semiquantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.

Between March 1989 and August 1990, we performed 21 stapled J pouch ileonal procedures (20 ulcerative colitis [UC], 1 familial polyposis [FP]) without an ileostomy in 19, of whom 13 were taking prednisone and eight underwent semi-emergent surgery for uncontrollable bleeding. During the same time, an additional four patients required a standard ileonal procedure. The results of anal manometry and clinical function were compared to 25 patients who had previously undergone mucosal stripping and a sutured J pouch ileoanal anastomoses with a temporary diverting ileostomy between October 1982 and August 1990. During this same time period, an additional 19 patients underwent an anti-peristaltic reversed J pouch and 18 an S pouch, for a total of 83 ileoanal procedures. The reversed J pouch had a lower stool frequency than a standard J pouch but had an unacceptable incidence of complications and problems with pouch emptying. The S pouch had a stool frequency similar to the standard J pouch but provided greater length in patients with a short mesentery. Stapled J pouch ileoanal patients had a better (p less than 0.02) maximum and sphincter resting pressure (46 +/- 11 versus 34 +/- 12 mmHg), fewer (p less than 0.05) night-time accidents (22% versus 68%), daytime (17% versus 55%) or night-time (28 versus 61%) spotting, or use of a protective pad at night (11% versus 42%) than nonstapled J pouch ileoanal patients. Stool frequency was similar in the two groups. All but one UC patient had residual disease at the anastomosis. Anal mucosa between the dentate line and stapled anastomosis was 1.8 +/- 1.3 cm (range, 0 to 3.5 cm). Complications in the nonstapled J pouch group included 4 pouches excised (2 for complications, 2 for excessive stool frequency), 1 pelvic abscess, 2 stenosis requiring dilation under anesthesia, 1 enterocutaneous fistula after ileostomy closure, 1 ileostomy site hernia, and 2 small bowel obstructions. Of the 65 patients who underwent ileostomy closure in the entire series, 8 (12%) developed a complication requiring surgical intervention. Complications in the stapled group included 1 anastomotic leak, 1 pouch leak, and 1 pelvic abscess. Patients were managed successfully with drainage (all 3) and diverting ileostomy (1). One patient developed stenosis requiring dilation under anesthesia. The stapled J pouch ileoanal anastomosis is a simpler, safer procedure with less tension than a standard handsewn J pouch but leaves a very small cuff of residual disease. It provides significantly better stool control and may obviate the need for an ileostomy with its complications.

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding greater than or equal to 50 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semiquantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.

Four haptens analogous to phenylurea herbicides were synthesized. Immunogens and coating proteins prepared by coupling these haptens to human serum albumin and ovalbumin, respectively. Antisera raised in rabbits immunized with three of the immunogens bound strongly to microtitration plates coated with homologous hapten, such that competitive assays were developed using heterologous coating proteins. The assay systems were characterized with respect to specificity to 13 related compounds and one selected for application to the determination of monolinuron, diuron, and linuron in foods. Satisfactory recrovery data were obtained by direct analysis of methanol extracts of foods fortified with 40–160 ng/g monolinuron or 0.25–2.0 μg/g diuron. Solvent partitioning and silicic acid column chromatography were only partially successful in removing interferences in the determination of linuron.

This, the final paper in this three-part series, looks at how patients evaluate the dental care they receive and how this translates into either satisfaction, dissatisfaction or something in between. It explains how it might be possible to manage patient expectations so that patients are more likely to be satisfied with all aspects of the care provided and describes a framework for dentists and staff to use when trying to enhance patient experience in everyday dental practice.By better understanding the concept of 'patient satisfaction' dentists can develop strategies that take into account the way patients evaluate the quality of their own dental care.

This paper describes the value and use of quality of life measures to dental practice, how to assess oral health-related quality of life in dental practice and how to interpret what they mean when assessing patients' oral health needs and evaluating outcomes from dental care.

This paper explores the way that patient participation has increased in dentistry in recent years and introduces the two concepts of ‘quality of life’ and ‘patient satisfaction’ and examines their relevance to everyday clinical dental practice.

This resource is a website that was developed to bring together learning material and information in the area of professionalism for students, housestaff, and faculty at medical schools. Features include standards and policies for medical schools, health systems, and medical centers; a description of a professionalism committee and the reporting mechanism for perceived unprofessional behavior; a section to support teaching and learning, including teaching cases, presentations, references, original research, and case studies; and news about local events related to professionalism including ceremonies, awards and other opportunities for recognition, and presentations. Using a logic model, we evaluated this effort by linking activities, outputs, outcomes, and impacts. Outputs and outcomes include dissemination of professionalism policies and standards; a “standard of the month” reminder; and three Group on Education Affairs regional meeting poster presentations. This website has also been included in faculty development for graduate medical educators program directors and undergraduate medical education course directors and in departmental grand rounds. The website does not remain static and is continuously updated and maintained in order to be useful. There has been a very positive reaction to making all of these resources available in one place. This website is an ongoing team effort by the admissions, undergraduate education, housestaff education, faculty, instructional development, and student activities offices at the Virginia Commonwealth University Medical Center and the Hunter Holmes McGuire Veterans Administration Medical Center.

To evaluate the cumulative survival (CS) rates of fixed partial dentures (FPDs) retained by full-veneer retainers, and those of resin-bonded FPDs provided by graduating dental students for the replacement of a single missing tooth. In 168 patients, 61 3-unit fixed-fixed FPDs and 25 2-unit cantilevered FPDs retained by full-veneer retainers, and 77 3-unit fixed-fixed resin-bonded FPDs and 47 2-unit cantilevered resin-bonded FPDs, were examined for their retention and integrity. The periodontal health, endodontic status and coronal tissues of all abutment teeth were also evaluated. The survival rates of these various designs were analysed with the Kaplan-Meier method. The mean age of all FPDs was 31 months. At 48 months after their insertion, 3-unit FPDs retained by full-veneer retainers had a CS rate of 82%, followed by 2-unit resin-bonded FPDs at 81%, 2-unit FPDs retained by full-veneer retainers at 77%, and 3-unit resin-bonded FPDs at 63%. No significant difference was found between the four designs (P>0.05). Up to both 48 and 60 months, the most common causes of failure were endodontic for FPDs retained by full-veneer retainers, and dislodgement for resin-bonded FPDs. The 3-unit fixed-fixed FPDs retained by full-veneer retainers had the most favourable prognosis after 48 months for replacing a single missing tooth, but the difference between designs was not statistically significant.

The Canadian Total Diet Study is a national survey to determine the level of chemical contaminants in the Canadian food supply. Food samples were collected from Whitehorse, Yukon, supermarkets as part of the study in 1998. Whitehorse was chosen as a sampling centre, despite its small population (n = 19,000), to determine if residue levels were different in foods available in northern communities relative to levels observed in previous studies in the more populated south. Foods were prepared as for consumption before pesticide residue analysis. Residue levels observed in most foods were similar to levels observed in samples from previous surveys from southern Canadian cities. Malathion and DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene), a transformation product of DDT (1,1,1-trichloro-2,2-bis(p-chlorophenyl(ethane), were the two most frequently detected compounds (26.4 and 25.8%, respectively). The majority of pesticides, however, had a detection frequency of < 5%. In general, pesticides in food composites were well below maximum residue limits established in the Canadian Food and Drug Regulations. Chlorpropham and captan had the highest dietary intakes (2.16 and 1.94 micrograms (kg body weight-day)-1, respectively), based on the results from Whitehorse. No dietary intakes above the acceptable daily intakes, however, were observed for any of the 39 pesticides investigated in any age-sex category, where an acceptable daily intake has been proposed.

To investigate the prevalence and pattern of impacted teeth and associated pathologies in the Hong Kong Chinese population.The Reception and Primary Care Clinic, Prince Philip Dental Hospital, Hong Kong.Retrospective study.The records of 7486 patients were examined to determine whether the chief complaints were related to impacted teeth and associated pathologies, which were investigated using panoramic radiographs.A total of 2115 (28.3%) patients presented with at least one impacted tooth. Among the 3853 impacted teeth, mandibular third molars were the most common (82.5%), followed by maxillary third molars (15.6%), and maxillary canines (0.8%). Approximately 8% of mandibular second molars associated with impacted third molars had periodontal bone loss of more than 5 mm on their distal surfaces. Caries were also found on the same surfaces in approximately 7% of the second molars. Approximately 30% of patients with dental impaction had symptoms, and 75% had complaints limited to one side of the mouth.The prevalence of impacted teeth was high, and there was a predilection for impacted third molars in the mandible. More than 50% of maxillary third molars had erupted, creating potential trauma of the pericoronal tissues of the partially erupted mandibular third molars. Caries and periodontal diseases were commonly seen in relation to the impacted third molars, whereas cystic pathology and root resorption were rarely observed.

There can be few who would argue with the notion that the nature of dental practice in the United Kingdom has changed dramatically over the last couple of decades. A variety of factors, including new clinical techniques, growing consumerism, a much greater awareness of health-related and well-being issues in the public at large, as well as a marked deregulation within the dental profession, the development of vocational training and recently mandatory lifelong learning, the growing number of females working in the profession, and an increasing reluctance of young dentists to finance dental practices have all combined to create an environment which has enabled and encouraged a move away from traditional forms of dental care delivery. Instead, there has been considerable growth in independently-funded practice and a commensurate growth in the number of practices operating under a corporate body umbrella of one form or another.1 Currently there are 27 corporate bodies registered with the General Dental Council (GDC) with the likelihood of more in the future given the proposed GDC review. This will no doubt take into consideration European law, under which the restriction within the Dentist's Act on the number of corporate bodies is likely to be untenable. Although they still have only a small share of the dental market—with 4% of all dentists in the UK in 19992— they have expanded rapidly from a small base. The data available at the time the paper was written indicate that the global total of fees earned from dentistry in the UK in the financial year 2001/2002 was almost £3 billion, of which £1.9 billion (64%) came from NHS fees3 and £1.1 billion (36%) from private fees. Of this £1.9 billion received in NHS fees in 2001/2002, £0.55 billion were paid by patients who were not exempt from charges, bringing the total amount actually paid out of patients’ pockets for dental treatment to £1.65 billion. Compare these figures with 1996/1997 when NHS fees stood at £ 1.6 billion (71%) and private fees at £0.6 billion (29%) and it can be seen that while the size of the whole market has grown NHS fees have risen by around 18% while private sector fees have gone up by 64% during the same period. It can not be said therefore that NHS dentistry has disappeared, although it is clear that access to NHS dentistry has been and may still be difficult in some parts of the country.4 The Department of Health in England has responded by developing ‘access centres’ and in the recently published Options for Change5 sets out sweeping proposals to revitalise NHS dentistry and delegate decisions over funding to a local level. It is far from clear what the consequences of these changes will be. How ever, one possible scenario is that in many parts of the UK, although relief of pain, prevention and restoration of function will be funded by the NHS, other than in ‘special circumstances’ such as after trauma and inherited conditions ‘cosmetic embellishment’ will not be funded. In which case, ever increasing public interest in personal appearance may well lead to further growth in private dentistry. Against a background of change and uncertainty, this series of articles explores some of the issues facing dentists coming to terms with working in this brave new world. This first part examines an aspect of dental practice that is seldom discussed openly and yet is of such fundamental importance that it is the cornerstone of all successful practices and the main fault line in unsuccessful ones, namely the nature and strength of practice values.

The provision of removable partial dentures remains a viable treatment modality for many partially dentate patients. Replacing missing anterior teeth with a removable partial denture using a rotational path of insertion provides improved retention and appearance. The use of a rotational path of insertion also provides additional retention for a removable partial denture restoring combined anterior and posterior bounded saddles. Two case reports demonstrate the use of the rotational path of insertion for partial denture design.

Numerous designs for posterior resin-bonded fixed partial dentures have been reported in the dental literature, but a methodical technique is still lacking. A groove, plate, and strut approach involving minimal preparation of posterior abutments to receive a resin-bonded fixed partial dentures is presented. The essential clinical and laboratory procedures are illustrated.

Mineral, spring and other bottled drinking waters sold in Canada in the winter of 1995-96 were surveyed for chlorate, bromide, bromate, Cr(VI), Li, B, Al, Mn, Cu, Zn, Sr, Ba, Be, V, Cr, Co, Ni, As, Se, Mo, Ag, Cd, Sb, Tl, Pb, Na, K, Ca and Mg. Chlorate and bromide were determined by ion chromatography (IC) with conductivity detection, Cr(VI) by IC with colorimetric detection, bromate by solvent extraction and gas chromatography (GC), trace elements by inductively coupled plasma mass spectrometry (ICPMS), and Na, K, Ca and Mg by flame atomic absorption spectrometry (FAA). Most chemicals in the 199 samples analysed were well within national and international drinking water guidelines. World Health Organization and/or Canadian drinking water guidelines were exceeded for B (22 samples), Al (9), Cr (1), Mn (5), Ni (1), As (10), Se (24) and Pb (1). Bromate levels are reported for information purposes and are considered as the maximum concentrations in the samples. In three distilled water products, unexpectedly high concentrations of Cu (88-147 micro g l(-1)) and Ni (16-35 micro g l(-1)) were found, and a comparison of distilled and non-distilled waters from two of the brands suggested the likely cause to be contamination during the distillation process. Li concentration in one sample was at a therapeutic dose and could pose an overdose risk to individuals on Li medication.

In the management of localized posterior occlusal toothwear, care must be taken not only in determining whether the worn teeth are restorable, but also the desirable occlusal scheme. Assessments of the periodontal, endodontic, and coronal tooth tissues, and the occlusal relationship are necessary for a comprehensive treatment plan for worn posterior teeth.

In this, the first of a four-part series on the restorative management of the worn dentition, the aetiological factors, diagnosis of toothwear and preventive measures are summarized. Later papers will deal with the management of localized anterior and posterior toothwear, the use of 'Dahl type' appliances as an effective means for the restorations and the various treatment options for the management of the dentition showing generalized wear. The series will discuss the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition.

Aim To discover the quality of written instructions from dentists to dental technicians and the nature of non-compliant prescriptions. Method An audit of laboratory prescription compliance was conducted within an NHS Trust Dental Teaching Hospital to determine the level of communication between dentists and dental technicians. One hundred and fifty prescriptions were audited from dental undergraduates and qualified dentists throughout the different departments. Results A total of two-thirds of prescriptions were considered non-compliant and failed to meet relevant ethical and legal guidelines. This problem was seen throughout all departments and at all professional levels. Conclusion A breakdown in communication between dentists and technicians through the use of prescriptions is evident even within a close working environment.

cis-Nonachlor and trans-nonachlor are bioaccumulating components of the pesticide chlordane, which can be detected in various environmental biota and in humans. Existing studies have focused on the potential adverse health effects of the parent chlordane mixture. Comparable toxicity data are nonexistent for individual chlordane constituents such as trans-nonachlor, cis-nonachlor, or oxychlordane, which are among the most common chlordane-related environmental contaminants and tissue residues. In this study, rats were administered cis-nonachlor, trans-nonachlor, or technical chlordane by gavage for 28 days at doses of 0.25 to 25 mg/kg body weight. Residue analyses indicated that trans-nonachlor accumulation in adipose was greater than cis-nonachlor when rats were administered each chemical under identical conditions of dose and exposure. For all test chemicals, the major metabolite oxychlordane accumulated in adipose tissue. Adipose tissue residue levels of all test chemicals and the major metabolite were higher in female rats. The liver was a target organ in male and female rats, indicated by increased liver weight and histopathological changes consistent with microsomal enzyme induction. Hepatic changes were most pronounced in rats treated with trans-nonachlor. Elevated kidney weights and depressed organic ion transport were observed in males treated with trans-nonachlor and chlordane. Although in general, changes in target organs and clinical chemistry endpoints were similar for all 3 test chemicals, the approximate toxicity ranking from most to least toxic was trans-nonachlor > technical chlordane > cis-nonachlor.

To evaluate continued experience with a one-stage stapled ileoanal pouch procedure without temporary ileostomy diversion.Most centers perform colectomy, proctectomy, and ileal pouch anal anastomoses (IPAA) with a protective ileostomy. Following a previous report, the authors performed 126 additional stapled IPAA procedures for ulcerative colitis and familial adenomatous polyposis, of which all but 2 were without an ileostomy. Outcomes in these patients question the need for temporary ileal diversion, with its complications and need for subsequent surgical closure.Two hundred one patients underwent a stapled IPAA since May 1989, 192 as a one-stage procedure without ileostomy, and 1 with a concurrent Whipple procedure for duodenal adenocarcinoma. Patient charts were reviewed or patients were contacted by phone to evaluate their clinical status at least 1 year after their surgery.Among the patients who underwent the one-stage procedure, 178 had ulcerative colitis (38 fulminant), 5 had Crohn's disease (diagnosed after IPAA), 1 had indeterminate colitis, and 8 had familial adenomatous polyposis. The mean age was 38 +/- 7 (range 7--70) years; there were 98 male patients and 94 female patients. The average amount of diseased tissue between the dentate line and the anastomosis was 0.9 +/- 0.1 cm, with 35% of the anastomoses at the dentate line. With 89% follow-up at 1 year or more (mean 5.1 +/- 2.4 years) after surgery, the average 24-hour stool frequency was 7.1 +/- 3.3, of which 0.9 +/- 1.4 were at night. Daytime stool control was 95% and night-time control was 90%. Only 2.3% needed to wear a perineal pad. Average length of hospital stay was 10 +/- 0.3 days, with 1.5 +/- 0.5 days readmission for complications. Abscesses or enteric leaks occurred in 23 patients; IPAA function was excellent in 19 of these patients (2 have permanent ileostomies). In patients taking steroids, there was no significant difference in leak rate with duration of use (29 +/- 8 with vs. 22 +/- 2 months without leak) or dose (32 +/- 13 mg with vs. 35 +/- 3 mg without leak). Two (1%) patients died (myocardial infarction, mesenteric infarction).The triple-stapled IPAA without temporary ileal diversion has a relatively low complication rate and a low rate of small bowel obstruction, provides excellent fecal control, permits an early return to a functional life, and can be performed in morbidly obese and older patients.