1 Myth or Fact: Dentistry Damages Devices? Pacemakers and other ...

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  • 1 Myth or Fact: Dentistry Damages Devices? Pacemakers and other ...

    1. 1. Myth or Fact: Dentistry Damages Devices? <ul><li>Pacemakers and other programmable devices are susceptible to electromagnetic radiation </li></ul><ul><li>Unipolar devices are less susceptible but still can be affected </li></ul><ul><li>Shielding and refinements in cellphones and devices reducing risk </li></ul>
    2. 2. Myth or Fact: Dentistry Damages Devices and Data? <ul><li>Miller CS et al. Selective interference with pacemaker activity by electrical dental devices. OOOOE 1998;85:33-6 </li></ul><ul><li>Regardless of polarity, pacemakers were affected by electrosurgery, ultrasonic scaler and ultrasonic cleaner </li></ul><ul><li>Handpieces, amalgamator, curing light, pulp tester, x-ray unit, and sonic scaler were all benign </li></ul><ul><li>Electric toothbrushes ok </li></ul>
    3. 3. Anything Else? <ul><li>Anecdote: My cardiology colleagues say that in some patients with CHD, the reduced IE coverage is prompting delay in repair </li></ul><ul><li>Low-dose anti-neoplastics are growing in popularity (multiple sclerosis and cyclophosphamide) </li></ul><ul><li>Implanted “pacers” are increasing in use (gastroparesis) </li></ul><ul><li>Do not assume that historical disease-treatment patterns hold in today’s pediatric medicine! </li></ul>
    4. 4. Periodicity of care MYTHBUSTERS Trooth-Busters
    5. 5. Periodicity of care MYTHBUSTERS Trooth-Busters
    6. 6. Recall Frequency <ul><li>Cochrane Collaboration: </li></ul><ul><li>1. Beirne PV, Clarkson JE, Worthington HV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2007, Issue 3. </li></ul><ul><li>NGCH- refers to AAPD Reference Manual </li></ul><ul><li>AAP : </li></ul><ul><li>1. Bright Futures: A National Health Promotion Initiative </li></ul><ul><li>AAP 3 rd ed. </li></ul><ul><li>EBD/ADA: </li></ul><ul><li>1. The effectiveness of routine dental checks: a systematic review of the evidence base Davenport CF, Elley KM, Fry-Smith A, Taylor-Weetman CL, Taylor RS. Br Dent J. 2003; 195(2):87-98; </li></ul><ul><li>Frequency should be based on risk of the child and not the calendar , insurance policies or the beginning of the school year </li></ul><ul><li>How about the ordering of radiographs? </li></ul><ul><li>Hold on, it’s coming! </li></ul>
    7. 7. Caries Risk Assessment <ul><li>ADA/EBD: </li></ul><ul><li>1. Caries risk assessment and prevention: strategies for Head Start, Early Head Start, and WIC Kanellis MJ. J Public Health Dent. 2000; 60(3):210-7 </li></ul><ul><li>2. Caries Risk Assessment- Council on Clinical Practice </li></ul><ul><li>AAPD: </li></ul><ul><li>Policy on use of a caries risk assessment tool (CAT) Pediatri Cent 2008;30(suppl): 29-33 </li></ul><ul><li>AAP: </li></ul><ul><li>1. Promoting Oral Health, in Bright Futures: Guidelines for Health Supervision 3 rd ed. Elk Grove Village: AAP. </li></ul><ul><li>Cochran Collaboration: </li></ul><ul><li>1. Nothing </li></ul><ul><li>PubMed; </li></ul><ul><li>1. Prevention and Management of dental Decay in the pre-school child. Scottish Intercollegiate Guidelines Network, 2005 </li></ul>
    8. 8. Sign of caries risk <ul><li>12 month old infant </li></ul><ul><li>Initial Examination </li></ul><ul><li>Plaque on anterior teeth </li></ul><ul><li>Is there a risk for ECC? </li></ul><ul><li>EB Decision </li></ul><ul><li>‘ Reviews suggest that visible plaque on the labial surfaces of infants maxillary incisors is a sign of caries risk’ </li></ul><ul><li>Cochran Oral Health Group- nothing! </li></ul><ul><li> NGCH </li></ul><ul><li> 1.Clinical guideline on infant oral health care. AAPD  2004.  </li></ul><ul><li>Goggle </li></ul><ul><li> 1. Dental plaque - Wikipedia , the free encyclopedia </li></ul><ul><li>Dental plaque is biofilm (usually colorless) that builds up on the teeth . If not removed regularly, it can lead to dental cavities or periodontal problems (such as gingivitis). </li></ul><ul><li>ADA EBD </li></ul><ul><li> 1. Risk factors for dental caries in young children: a systematic review of the literature </li></ul><ul><li>Harris R, et al. Community Dent Health. 2004 </li></ul><ul><li> 2. Are mutans streptococci detected in preschool children a reliable predictive factor for dental caries risk? A systematic review </li></ul><ul><li>Thenisch NL, et al Caries Res. 2006;40(5):366-74 </li></ul><ul><li>PubMed </li></ul><ul><li>1. Early Plaque accumulation- a sign for caries risk in young children. Alaluusua S et al. 1994. </li></ul><ul><li>2. Effect of Mutans Streptococcal Colonization on Plaque Formation and regrowth in young children. Lee C et al. 2008; </li></ul>
    9. 9. Caries Risk Assessment Tool 1.Component in the clinical decision making process 2. Risk factors vary with race, culture and time 3. Requires social, behavioral , environmental information 4. At initial examination and periodically as risks change
    10. 10. Periodicity of Radiographs <ul><li>Ordering of radiographs only after a review of histories, completing a dental examination and a risk assessment. </li></ul><ul><li>Order only if the child’s cooperation is acceptable </li></ul><ul><li>Order only if there is an expectation that the information will affect patient care </li></ul><ul><li>Minimize patient’s exposure </li></ul><ul><li>Ionizing radiation can result in high cumulative effective doses of radiation </li></ul><ul><li>The Selection of Patients for X-Ray Examinations. DHHS, CDRH, 1987 </li></ul><ul><li>The Selection of Patients for X-Ray Examinations. FDA/ADA, 2004 </li></ul><ul><li>Exposure to Low-Dose Ionizing Radiation. Fazel et al. NEJM 2009 </li></ul>
    11. 11. Evidence and Guidelines change- Our search for excellence hasn’t !
    12. 12. MYTHBUSTERS Trooth-Busters

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