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By F. Baldar. Occidental College.

Some researchers report that argon laser irradiation produces a surface with enhanced caries resistance generic tadacip 20 mg line. Several authors have studied these by creating plaque retentive areas on teeth destined to be removed for orthodontic reasons and recorded the effect that different pre-treatments had prior to 6 weeks of plaque accumulation purchase 20 mg tadacip with amex. Pre-treatment with an argon laser led to less lesion formation and improved further if combined with topical fluoride application tadacip 20 mg with visa. The results seem very impressive but need replication in the long term cheap tadacip 20mg, in the form of controlled clinical trials buy 20mg tadacip with mastercard, to determine the significance in a population as a whole instead of specific artificially created caries prone areas. If proven they may yield a simple non- invasive and pain free technique for reducing caries susceptibility of enamel. Resin curing Argon lasers are able to polymerize composite resins in a shorter time than conventional light sources. The use of this type of laser has the additional advantage of increasing the ability of tooth structure to resist cariogenic challenges and may also increase resistance of the enamel surrounding the polymerized resin. One study also found that laser polymerization lowered the proportion of non-polymerized monomer and slightly improved the physical properties of the resin in comparison to visible- light methods of curing. It is important to remember that resins cured with lasers do not necessarily have superior physical properties and it is particularly important to check that the initiators within the resin are activated at the specific wavelength of the laser. Laser bleaching Both carbon dioxide and argon lasers have been suggested as a method of tooth whitening. There have been no controlled clinical studies and there are concerns regarding the pulpal safety in connection with carbon dioxide lasers, so the use of this type of laser is not recommended. In one study an argon ion laser produced less temperature rise when used to increase the activity of a bleaching gel compared with conventional quartz tungsten; hence, plasma arc lights may be acceptable. Enamel etching It has been suggested that laser irradiation may eliminate the need for etching, but as yet there is not scientific literature to back this claim. In summary, some of the preliminary reports on the use of lasers give much room for optimism. They not only suggest that it might be possible to use lasers to help prevent decay, but it may also be possible to perform certain surgeries and prepare cavities with little pain for the patient. However, greater clinical trial validation of these claims is needed before lasers can be considered superior to conventional methods, so that failure to utilize the former will be considered as a disservice to the patients. If the child presents with an acute problem of pain or swelling, then immediate treatment is indicated to relieve the child of the pain. After that, it is important that the clinician considers the attitude of the child and his or her parents together with motivation towards dental treatment, the co-operation of the child, the age, and the extent of decay. It may be possible to place temporary restorations while preventive strategies are commenced. Plaque control, oral hygiene instruction depending on age to the child or the parent, the techniques of toothbrushing, and disclosure. Her whole attitude to dentistry needs to change in order to treat her successfully. A full preventive programme, to attempt to treat the cause of the caries, must accompany any restorative treatment. Early treatment of occlusal surface caries saves tooth tissue but with early approximal lesions use remineralization wherever the lesion has not reached the dentine. Consideration should be given to pulp preservation in deep lesions in immature permanent teeth. Hypomineralized first molars deteriorate rapidly, can be extremely sensitive and require early treatment 6. Treat with caution until long-term clinical trial results verify the claims of the initial researchers. British Society of Paediatric Dentistry: a policy document on fissure sealants in paediatric dentistry. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 2002/2003. There is considerable overlap in the application of the various restorative techniques; therefore the chapter is divided into two parts: the first outlines the clinical steps involved in the various procedures, while the second covers the more general principles of management of the particular dental problems. With the aid of some clinical examples, seven of the restorative procedures will be described in simple stages.

A one-sample t-test is more flexible than a paired t-test cheap tadacip 20mg with amex, which is limited to testing whether the mean difference is significantly different from zero generic tadacip 20mg amex. A one-sample t-test can be used to test if the population mean is equal to a specified value order tadacip 20 mg amex. A one-sample t-test is a parametric test and the assumptions are that firstly discount tadacip 20mg with mastercard, the data are normally distributed and secondly purchase 20mg tadacip with mastercard, the observations are independent. If the assumptions of a one sample t-test are not satisfied, a non-parametric equivalent test, that is, a Wilcoxon signed rank test may be conducted. Computing per cent changes provides control over the units that the changes are expressed in and their direction of effect. Paired and one-sample t-tests 103 For the research question, the command sequence shown in Box 4. The means in this table show that the per cent increase in weight over 2 months is larger than the per cent increase in length and head circum- ference. The highly significant P values are reflected in the 95% confidence intervals, none of which contain the zero value. The outcomes are now all in the same units, that is per cent change, and therefore growth rates between the three variables can be directly compared. This was not possible before when the variables were in their origi- nal units of measurement. As before, Cohen’s d can be calculated as the mean divided by the standard deviation using the values reported in the One-Sample Statistics table. These differ slightly from the effect sizes computed for a paired t-test because the variables are now in different standardized units and the mean difference and per cent increase have different standard deviations. The effect sizes rank length as having the largest effect size, whereas weight has the largest per cent increase. In some disciplines such as psychology, the t value is also reported with its degrees of freedom, for example as t (276) = 51. However, since the only interpreta- tion of the t value and its degrees of freedom is the P value, it is often excluded from summary tables. Research question The research question can now be extended to ask if certain groups, such as males and females, have different patterns or rates of growth. Questions: Over a 2-month period: Do males increase in weight significantly more than females? Null Over a 2-month period: hypothesis: There is no difference between males and females in weight growth. Variables: Outcome variables = per cent increase in length, weight and head circumference (continuous) Explanatory variable = gender (categorical, binary) Paired and one-sample t-tests 105 The research question then becomes a two-sample t-test again because there is a con- tinuously distributed variable (per cent change) and a binary group variable with two levels that are independent (male, female). Once again, the distributions of per cent change should be fully checked for normality using Analyze → Descriptive Statistics → Explore as discussed in Chapter 2 and that test assumptions have been satisfied before conducting a two-sample or independent t-test. These statistics are useful for summarizing the magnitude of the differences in each gender. In the Independent Samples Test table, the Levene’s test of equality of variances shows that the variances are not significantly different between genders for weight (P = 0. However, the variance in per cent change for length is signif- icantly different between the genders (P = 0. An indication that the variances are unequal could be seen in the previ- ous Group Statistics table, which shows that the standard deviation for per cent change in length is 3. An estimate of the variances can be obtained by squaring the standard deviations to give 10. Thus, the Independent Samples Test table shows that per cent increase in weight is significantly different between the genders at P = 0. This is reflected in the 95% confidence intervals, which do not cross zero for weight, cross zero marginally for length and encompass zero for head circumference. One-sample t-tests can be used to test whether the mean per cent increase is significantly different from zero for each gender. After the commands have been completed, the message Split File On will appear in the bottom right hand side of the Data Editor screen. The One-Sample Test table provides a P value for the significance of the per cent change from baseline for each gender and also gives the 95% confidence intervals around the mean changes. Another alternative to obtaining summary means for each gender is to use the commands shown in Box 4. Although a one-tailed P value is used for the significance of increases in body size because we only expect babies to increase in body size, a two-tailed P value is used for between-gender comparisons because the direction of effect between genders is not certain.

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In The prevalence of dental caries may increase as addition order tadacip 20 mg otc, as the economies of many nations improve buy discount tadacip 20mg, urbanization increases order tadacip 20 mg line, especially in developing there will be a greater demand for periodontal care buy 20 mg tadacip mastercard. Progress in lower-income these demographic and disease trends and to devel- or in emerging-market economies would be slower order 20mg tadacip free shipping. As the population In the latter, availability of affordable products for ages, the systems by which health care is delivered, prevention would be a real issue. Middle- or health care having oral complications might be income and emerging-market countries that experi- facilitated by examining solutions and options in ence rapid dislocations of traditional institutions countries that have already come to terms with this and cultural practices might undergo changes in demographic phenomenon. Italy, Greece, and Sweden topped As populations age throughout the world, they will the list, followed by Belgium and Spain. In 1996, experience multiple chronic debilitating diseases, as well the estimated number of persons in the world 60 as more complex oral conditions, multiplying the chal- years of age and older was 550 million; by 2025 lenges for the dental professional familiar with the pre- there will be 1. Older populations in the least developed odontal diseases in individuals with no other health countries are growing much more rapidly than those concerns. The challenge is to understand how signifi- cant these demographic and disease trends might be Oral cancers will continue to be a major and grow- and to develop a strategy to meet these needs. In the interest of profit making, the delivery of prevention, early diagnosis and manage- private sector may abandon or ignore the economi- ment of oral and nasopharyngeal cancers will cally disenfranchised, the elderly, the poor, the remain an issue. This may not be the only organization of that will enable graduates of those accredited insti- its kind but its very existence portends that global- tutions to circumvent the requirement to matricu- ization of health systems is a trend that is likely to late in a United States dental school for 2 years prior affect oral health. These populations in par- ly personnel, such as dental nurses, to provide ticular need the industrialized world to provide them needed preventive and restorative services in some affordable prevention products and to help them countries in the South Pacific, Asia, Africa, and the develop treatment services that can be delivered by Caribbean. Teledentistry for remote site care should parallel x Because of the severe shortage of faculty in United and augment the trend for telemedicine and tele- States dental schools, the search for clinical and health, which is also applicable for delivery of home research faculty has increasingly looked to the glob- health care and geriatric services. Legislative initiatives in Congress are pushing to Dental Curricula exempt highly skilled professionals working in uni- versities from current limitations on the number of x The European Union DentEd project has resulted visas available. While some of these efforts are driv- in dental school visitations by international teams of en by shortages in personnel with highly technical educators, which in turn pull together intellectual computer skills, it is conceivable that similar legisla- resources across nations to focus on issues of dental tive initiatives might permit more flexible visa poli- curricula. This trend toward purposeful sharing of cies for university faculty in the health sciences. Joint visitations also seem to be considering strate- Distance Education gic planning and outcome assessment tools that can be used universally (see www. Distance should no curricula is increasing, though it will be many years longer be an impediment to students, faculty, or cli- before the evidence validating this approach will be nicians in any location. Comparative analysis of the effectiveness able to provide certain courses directly, based on of these approaches to learning will provide valu- availability of expertise. When direct provision is able insights for United States educators as dental not possible, they will be able to fill in voids through curricular materials continue to be updated. It should not needs of the aging patient presented with several be necessary to recreate each time a course is devel- diseases/conditions, and that graduates of dental oped. Use of these technologies not only will professional schools be prepared for multiple improve the quality of education in schools career options given that the length of active work life throughout the world but also will enable faster is likely to increase. Dental Personnel x Technology also will benefit international dental x Accreditation of non-U. Although the costs of electronic communication will continue to be a major factor, The trend towards creating a high-level focus for especially for poorer nations, the Internet will con- international collaborative oral health research within tinue to expand rapidly and will be utilized exten- the United States demonstrates a willingness to work sively throughout the world. The following are with global partners to achieve common humanitarian advantages of international communication: and scientific objectives. The trends in most areas of dental research indicate a need to draw expertise from x Dentists will be able to easily access publications wherever in the world that expertise exists. This will enable all dentists to Networking of scientists in the United States with col- share in learning, even from parts of the world leagues around the world will be the normative model where they currently do not have access to infor- for research in the 21st century. This means that in many countries, dentists will be able to share information, and participate in con- x Expanded research support to finance interna- tinuing education, without leaving home. Cost-sharing by x Real-time, simultaneous translation will overcome international funders in the public and private sector any language barriers, and a true community of pro- is essential for maintaining these networks, and fessionals will exist. United States leadership is needed to spearhead the science as these teams develop and pursue such x Continuing education will become worldwide in questions of global significance. Clinical procedures performed will be viewed in real time via the Internet or saved for viewing at a x Advocacy for the development of sustainable more convenient time. Unless these are in place, such x Within the context of dental education, commu- lack of infrastructure will thwart the progress of nication will take on many new changes on a knowledge developments applicable to the United worldwide basis. The oppor- tunities for education and communication through x Providing training for researchers from develop- technology are unlimited. A side benefit is that United States dental products and There are overall national gains in oral health in technologies might gain entry into overseas markets, the United States.

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The sources of radioactive materials are the hospitals 20mg tadacip, research facilities generic 20 mg tadacip, and industrial and construction sites where radioactivity is used for various purposes (diagnosis and treatment at hospitals best tadacip 20mg, research work generic tadacip 20 mg line, sterilizing equipment proven tadacip 20mg, and check of welding). Some of the highly radioactive sources are cobolt-60, strontium-90, cesium-137, and iridium-192 used in industrial Dirty Bombs 261 radiographic services. Many of these sources are mostly in metallic capsule form and the likelihood of dis- persion is minimal. However, they can be available in liquid and powder forms and potentially be used in dirty bombs, which can result in wide- spread contamination in the surrounding areas of explosion. Because one cannot see, taste, or feel radiations, excessive exposure can be received unknowingly by people in the vicinity of the area. Types of Radiation Exposure Radiation exposure from radiation accidents can be localized and/or whole- body type. The localized exposure may be caused by direct handling of or close proximity to highly radioactive sources. The local injury includes ery- thema, epilation, desquamation, ulceration, or blistering depending on the level of exposure. The treatment of choice for localized injuries is the use of antibiotic for infection and control of pain. The whole-body exposure causes various acute radiation syndromes that have been discussed earlier in this chapter. These syndromes include hemo- poietic, gastrointestinal, and cerebrovascular syndromes depending on the absorbed doses. Although cerebrovascular syndromes occur with 10,000 rem (100Sv), and result in death, the hemopoietic and gastrointestinal syn- dromes may be managed by bone marrow transplantation and other pro- phylactic treatment. Internal contamination can occur from the inges- tion of contaminated food and water, inhalation of the contaminated air, and diffusion through the skin or wounds. The principle of the treatment of internal contamination primarily involves dilution, displacement by non- radioactive material, complex formation, and blockage. Outer garments such as clothing and shoes can be contaminated by radioactivity from the explosion of a dirty bomb. Such contamination does not constitute a medical emergency and most of it can be removed by taking off these garments. Minor skin contamination can be eliminated by thor- ough washing with water and detergent, and a shower, if appropriate. Skin should not be abraded by a heavy brush, as this may facilitate internal absorption. Radiation Biology the external contamination, the patient must be first managed for the con- dition before decontamination is carried out. Burns and wounds that are not contaminated should be first covered and then decontamination of the other affected areas carried out. If you are outside and close to the explosion of a dirty bomb, cover the nose and mouth with a mask or cloth to reduce the risk of breathing in radioactive dust or smoke. If possible, immediately go inside the building that is not affected by the explosion and remove the outer layer of cloth- ing and shoes and seal them in a plastic bag, if available. If you are inside and close to the incident that has occurred outside, close all the doors and windows and do not leave the building. Local or federal authorities are likely to monitor the food and water in the area of explosion and inform the public of their suitability for consumption. Verification Card for Radioactive Patients After the September 11, 2001 attack on the World Trade Center in New York, numerous security measures have been adopted by the U. Congress has passed laws to establish the Department of Homeland Security to implement and monitor different aspects of these security measures. Security checks of airline passengers, background scrutiny of many visitors and suspected terrorist groups, and implementa- tion of the Patriot Act are some of the examples of these security actions Radiation Phobia 263 that are currently in place. In view of the concerns over the use of dirty bombs by miscreants, the Homeland Security has established checkpoints at various strategic locations such as airports, tunnels, mass transit, bridges, border crossing points, historical monuments, landmarks, and the like, to monitor the transport of dirty bombs containing radioactivity by using radi- ation detectors. One pitfall of this measure is that patients who received radioactive materials for diagnostic and therapeutic purposes may trigger the monitors while passing through these checkpoints and undergo undue hassle with authorities to provide proof that the radioactivity was really from medical uses. Many hospitals are adopting this policy and instruct the patients to carry the card for the period discussed below. A question arises as to how long the patient who has undergone nuclear studies should carry the card. It depends on the half-life of the radionuclide, types of radiations the radionuclide emits, and the biological elimination of the radiotracer from the body. Zuckier (2004) in a paper presented at The Radiological Society of North America annual meeting in Chicago sug- gested the following periods for different radionuclides for the patients to carry the card.

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