Quintessence International, 12/1997

Intracoronal bleaching of pulpless discolored teeth is a valuable treatment modality currently disregarded by many clinicians because of the potentially disastrous consequence of cervical resorption. A patient-administered, intracoronal caramide peroxide bleaching technique is described. This modified walking bleach method minimizes the risks because treatment time is reduced to days as opposed to weeks of the original walking bleach protocol; the concentration of the hydrogen peroxide is markedly reduced; and residual hydrogen peroxide is completely eliminated with the use of catalase prior to the definitive restoration.

Oral health care providers have taken various positions toward the concept of correct behavior toward and management of patients who are seropositive for human immunodeficiency virus. Several tribunal judgments and articles have discussed and analyzed this subject. This article presents a new detailed report and analysis and decision issued by a dental profession panel (tribunal) in Ontario, Canada. The concepts of universal precautions and antidiscriminatory acts are discussed.

Esthetically correct treatment of a localized alveolar ridge defect is a frequent prosthetic challenge. Such defects can be overcome not only by a variety of prosthetic means, but also by several periodontal surgical techniques, notably soft tissue augmentations. Preoperative classification of the localized alveolar ridge defect can be greatly useful in evaluating the prognosis and technical difficulties involved. A semiquantitative classification, dependent on the severity of vertical and horizontal dimensional loss, is proposed to supplement the recognized qualitative classification of a ridge defect. Various methods of soft tissue augmentation are evaluated, based on initial volumetric measurements. The roll flap technique is proposed when the problem is related to ridge quality (single-tooth defect with little horizontal and vertical loss). Larger defects in which a volumetric problem must be solved are corrected through the subepithelial connective tissue technique. Additional mucogingival problems (eg, insufficient gingival width, high frenum, gingival scarring, or tattoo) should not be corrected simultaneously with augmentation procedures. In these cases, the onlay transplant technique is favored.

The detrimental effect of focal infections on general health has been known for decades. Chronic dental infections may worsen the condition of medically compromised patients. Prophylactic antibiotics are therefore routinely prescribed before dental treatment to immunosuppressed and other at-risk patients to combat the spread of oral bacteria into the bloodstream. More recent studies have shown that dental infections may also be a risk factor for atherosclerosis and various other chronic diseases, emphasizing the need for frequent dental checkups among the diseased, in particular. The aim of this review article is to discuss some recent findings on the effect of dental infections on health in general. In many industrialized countries, there is an urgent need to focus on preventive dental care for the diseased and the elderly, whose oral health has been more or less neglected.