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Dental Specialties

Does crown-root ratio matter or not with an integrated implant?

(Content under development) The following linked questions were submitted by a practising dentist: Does crown-root (C/R) ratio matter or not with an integrated implant and, then more importantly, what do you do in your practice? What does the literature say about C/R ratio for implants with regard to short implants and crowns that are long or longer than the 50/50 guide for natural teeth? JCDA Editorial Consultants Drs. Reynaldo Todescan of the University of Manitoba, David Chvartszaid of the University of Toronto, and Ken Sutherland of the University of Saskatchewan provided these initial comments for consideration: According to Dr. Todescan: ...

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For the frail elderly, how often should fluoride varnish be applied and in what doses?

(Content under development) The following question was submitted by a practising dentist: I am working in a residential care centre with mostly frail elderly. I am looking for information on Fluoride varnish application and dental caries. How often should it be applied and in what doses? JCDA Editorial Consultants Drs. Michael MacEntee of Vancouver, Michael Wiseman and Rita Hurley of Montreal and Mary McNally of Halifax provided this initial discussion for consideration: Dr. McEntee opened the discussion: Management of caries requires a multifaceted approach (which includes applying fluoride varnish periodically), the primary objective of which is to stabilize the normal sequence ...

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What is the impact of emerging radiographic technologies on cumulative patient ionizing radiation exposure?

(Content under development) The following question was submitted by a practising dentist: I have seen an exponential growth in the marketing of CBCT to dentists (shouldn’t we ALL have one?), and have seen an emerging trend of dentists using them to reverse engineer pans etc. Most recently, an advert came across my desk where bitewings engineered from a pan are the answer. What is the impact of emerging radiographic technologies on cumulative patient ionizing radiation exposure? JCDA Editorial Consultants Drs Ernie Lam of the University of Toronto, Garnet Packota of the University of Saskatchewan and Elaine Orpe of Vancouver provided these ...

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What is the most effective antibiotic therapy for an acute odontogenic infection?

(Content under development) The following question was submitted by a practising dentist: What is the most effective antibiotic therapy for an acute odontogenic infection? If you ask the oral surgeons they say doxycycline , when you ask the infectious disease specialists they say amoxicillin. In the literature some papers state clindamycin and then others the combination of flagyl. JCDA Editorial Consultant Dr. Mark Donaldson of Kalispell, Montana provided this initial response for consideration: The correct antibiotic is the one that works! If we remember that the basic tenet of infectious diseases is to match the right drug to the right ...

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Advice on fluoride supplements for children in non-fluoridated areas

(Content under development) The following question was submitted by a practicing dentist: As I now practice in a newly “non-fluoridated” area I am looking at my recommendations for supplemental fluoride for my pediatric population. Are there any universally adopted guidelines available? JCDA Editorial Consultants Drs Felicity Hardwick of Nanaimo and Sarah Hulland of Calgary provided this initial response for consideration: Since the question relates to a newly non-fluoridated area we would firstly recommend that the dentist check that water fluoride status is indeed below the recommended optimal level of 0.7 ppm. Before prescribing fluoride supplements, a thorough clinical examination, dental ...

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Does placing a resin coating on a setting GIC impair fluoride release?

(Content under development) The following question was submitted by a practising dentist: Is there any solid evidence that the coating recommended for Resin Based Glass Ionomer Restorations impedes the release or uptake of Fluoride? JCDA Editorial Consultant Dr. Alan Kilistoff of the University of Alberta provided this initial response for consideration: The immediate answer is yes, but in context it is probably not clinically significant.  An article from Mazzaoui et al, demonstrates that fluoride release is about 75-90% less available after coating with a resin adhesive, but that fluoride is still available. The main purpose of the coating is to ...

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Does use of local antibiotic as an adjunct to flap surgery confer benefit?

(Content under development) The following question was submitted by a practising dentist: What is consensus on using local antibiotic with or without flap involvement? Is raising a flap and using antibiotics significantly better than without? JCDA Editorial Consultant Dr. Debora Matthews of Dalhousie University provided this initial response for consideration: When we talk about using antibiotics for our patients we have to think about the risk/benefit ratio. While the risk of systemic side effects is low, other potential risks exist, including increasing bacterial resistance, and the potential for allergic reactions. It is important to ask ourselves if these risks (for ...

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Does deep periodontal pocket disinfection with a soft tissue diode laser work?

(Content under development) The following question was submitted by a practising dentist: What clinical evidence is available for the efficacy of deep periodontal pocket disinfection with a soft tissue diode laser? What protocols are proven and recommended in terms of frequency of treatment? JCDA Editorial Consultant Dr. Debora Matthews of Dalhousie University provided this initial response for consideration:  There are two issues related to this question. The first is, does a soft tissue diode laser disinfect periodontal pockets (pocket disinfection therapy, or PDT)? The more important question, however, is whether diode lasers provide any additional clinical benefit over traditional scaling ...

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