Stomatolog y



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1.2 Examination of Patients


An examination should be conducted under a proper lighting, with a patient sitting at the chair of the stomatological unit, by examination tools (dental mirror, dental probe, dental forceps). Results of an examination should be entered into a patient’s medical record which serves for preparing a treatment plan. The first part of an examination is the anamnesis (case history). This part collects data that are related to a patients current illness and could influence a way of patient’s treatment.

Social anamnesis. Some data may indicate professional risks: e.g. higher cariousness at bakers or confectioners. Data about a patient’s habits may also be significant (smoking, drinking hard spirits), in relation to pre-cancerous states and malignant tumors.

Family anamnesis collects data on previous illnesses, surgeries and injuries. Data on cardiovascular diseases, metabolic disorders (diabetes, thyropathy), blood or hemocoagulation changes, allergic or paroxysmal states etc. Sometimes it is necessary to request a written report on a patient’s condition from a specialist. This report must state a proposed extent of a surgical treatment to be conducted.

Stomatologic anamnesis focuses on previous illnesses, surgeries or injuries of the orofacial area, about previous orthodontic, prosthetic treatments or dental surgeries, and about hygiene habits.

Extra-oral examination uses methods that are common in medicine, e.g. aspection, palpation, and also auscultation in the mandibular joint area. Careful examination and a qualified evaluation of its results may suggest a lot on the nature of a patient’s illness.

During an intra-oral examination, an attention is paid to the whole oral cavity. Not only the teeth should be examined, but also the mucosa of alveolar ridges, the tongue, the oral cavity base and the cheeks. Attention should also be paid to the ducts of large salivary glands and the appearance of saliva. Individual teeth are examined with the aid of the dental mirror and the probe so that all tooth surfaces can be inspected. The teeth of the permanent dentition are labeled with Arabic numbers from 1 to 8, milk dentition teeth are labeled by roman numerals from I to V. At present, the most frequently used numbering is that recommended by the international stomatology organization FDI (Féderation Dentaire Internationale). The quadrants of upper and lower jaws are labeled with numbers both for milk and permanent teeth. The permanent dentition quadrants are labeled as follows:


upper jaw right side left side

1 2


lower jaw 4 3
The milk dentition quadrant labeling is the following:
upper jaw right side left side

5 6


lower jaw 8 7
The quadrant number precedes a number that marks an individual tooth. For instance, the upper right canine tooth of the permanent dentition will be marked as 13, the same tooth of the milk dentition will be marked as 53.

Auxiliary examination methods complement the basic clinical examination. Besides some specialized methods (sonography, thermography), the most important is the X-ray examination. The intra-oral X-ray examination provides for an image of teeth and alveolar ridges, the extra-oral X-ray examination renders an image of the facial skeleton or the mandibular joint. Tomography provides for more detailed data by imaging a pre-selected layer of an object in a certain depth. Computer tomography (CT) is utilized in surgical dentistry mainly for imaging of the orofacial area tumors or during some injuries of the upper or middle third of the facial skeleton. The panoramic examination on the Status X instrument yields a surveying X-ray of teeth, e.g. when examining for a focal infection. Concurrent imaging of both jaws, nasal and maxillar sinuses and mandibular joints can be achieved by the orthopantomographic examination, e.g. using the AVANTEX instrument (Chirana). An X-ray exam with the use of contrast compounds is also frequently used. These compounds (e.g. iodinated oils - Lipiodol, or the barium suspension) absorb more X-rays than the surrounding tissues thus creating a positive contrast. This means of examination enables to follow morphological and functional manifestations of normal or pathologically altered organs, especially the large salivary glands (sialography), changes of the maxillar sinuses epithelium (antrography), eventually localization of cysts at the orofacial area (cystography).

Results of these examination methods can help significantly with determination of the correct diagnosis of an illness.



1.3 Biological Testing of Dental Materials


In 1978, the working team 5 of the Federation Dentaire International (FDI), the Commission for Dental Materials, Instruments, Tools and Therapeutics (COMIET) - today’s The Commission for Dental Products, have agreed upon the document No. 198 which was published in the bulletin No. 204. The bulletin describes recommended tests for evaluation of dental materials. It was published as the “ISO Technical Report”. The publication actually represented the first international attempt to set up procedures and rules for evaluation and testing of dental materials and assessment of their harmlessness upon the contact with human tissues. The report has reflected current level of knowledge at that time and showed readiness to modify or improve testing methods with the final goal of transforming this Technical report into an international norm. The report has been accepted internationally, except Australia and South Africa, by national government authorities as responsible for evaluation of safety of dental materials used on their territories.

The Czechoslovak stomatology has accepted these rules in the modified form in compliance with available laboratory testing methods and technology in 1986. This proposal also recommends standard methods for safety testing of dental materials designed for application into human tissues. This recommendation excludes pharmaceuticals, except those that are applied directly during a preserving or endodontic treatment. Tests of environmental factors effects and dental equipment effects are excluded as well. Recommended procedures include biological, not technical tests of materials. Results of proposed tests will be presented as a part of applications for clinical trials.



Testing concerns the following groups of materials:

  1. Materials for preserving stomatology - designed for a tooth reconstruction. Both metal and non-metal materials belong to this group. They are inserted into a tooth as a temporary or permanent fillings. They are in a short-term or permanent contact with tissues and the environment of the oral cavity.

  2. Prosthetic materials - designed for the teeth reconstruction. The impression materials will stay for a short time inside the oral cavity, materials for molding of dentures will stay there longer. Implantation materials remain in a tissue permanently.

  3. Materials for endodontics. These materials serve as disinfectants and fillings of the tooth pulp cavity. They may penetrate into the periapical ligamentous tissues and the bones via foramen apicis dentis. Compounds for devitalization of the pulp belong here, too.

  4. Materials for periodontics. These materials are used for treatment of the periodontium, come into a temporary contact with the oral mucosa, submucous ligaments and the bone of the alveolar ridge.

  5. Materials used in orthodontics. Remain inside the oral cavity for the period of up to several years.

  6. Materials for the oral surgery. Are present temporarily inside the oral cavity as plastic bandages or tissue glues.

  7. Materials for stomatological prevention. These materials enter the oral cavity for a long time. They are utilized for filling of dental fissures as a prevention of dental decay or for teeth cleaning.

General overview and the degree of testing are shown in Table 1.
Table 1.: Degree of biological testing of dental materials.

Initial tests

  • Short-term test of systemic toxicity (oral way)




  • Test of acute systemic toxicity (intravenous way)




  • Test of toxicity by inhalation




  • Hemolysis test




  • Coagulation tests




  • Ames test of mutagenicity




  • Clastogenic test




  • Cellular transformation test







  • Cytotoxicity tests

Secondary tests

  • Test of subcutaneous implantation




  • Test of implantation into a bone




  • Sensitization test




Application tests

  • Test of oral mucosa irritation




  • The pulp and dentine test




  • Test of materials used for the pulp overlay and pulpotomy




  • Endodontic application test




Initial tests:

  • The short-term test of systemic toxicity (oral way): the test is designed to evaluate toxicity of a material tested during a short-term oral administration.

  • Test of acute systemic toxicity (intravenous way): the test is designed to evaluate an acute toxicity during intravenous administration of studied material or extract.

  • Test of toxicity by inhalation: the test is designed to evaluate toxicity of materials or ingredients that are highly volatile at room temperature or under conditions of their use.

  • Hemolysis test: the test is designed to evaluate an acute, in vitro hemolytic activity of materials designed for a long-term contact with the bone and soft tissues.

  • Coagulation tests: the tests should show possible changes that might be evoked by tested samples in the blood coagulation system in vitro. These tests are supplementary.

  • Ames mutagenicity test: the test is designed to investigate mutagenic activity of solid or liquid materials, with recommendations for measurement of gases.

  • Clastogenic test: : the test is designed to investigate mutagenic activity of studied material on the chromosomal level. It is a supplementary test.

  • Test of cellular transformation: the test should determine a potential carcinogenic activity of materials studied.

  • Test of dominant lethality: the aim of this test is to measure the dominant lethality or mutagenicity of materials studied.

  • Cytotoxicity tests: the tests should check cytotoxicity of materials studied. A variety of modifications are utilized in this test according to possibilities of a laboratory. They may be as follows: the test of dynamic determination of contact cytotoxicity, the combined test of cytotoxicity of cellular morphology and metabolism, macro-contact method of the cytotoxicity test, cytotoxicity test in vitro, the test of tissue culture overlaid with agar, the test of proliferation of cells in culture, the test of dilatation of cells.

Secondary tests:



  • Test of subcutaneous implantation: the test is designed to evaluate a toxicity in vivo of tested materials designed for a long-term contact with subcutaneous tissues.

  • Test of implantation into a bone: the test is designed to evaluate a toxicity in vivo of tested materials designed for a long-term contact with the bone.

  • Sensitization test: the test is designed to evaluate a allergo-toxic potential of materials studied.

  • Test of the oral mucosa irritation: the test is designed to evaluate a tissue irritation by a tested material which will be temporarily or permanently adhered to the oral mucosa during its proposed use. This test may be employed as an application one as well.

Application tests:



  • Test of the oral mucosa irritation: the test was already described in the paragraph on secondary tests above.

  • The pulp and dentine test: the test is designed to study reactions of the pulp and dentine to procedures and filling materials.

  • Test of materials used for the pulp capping and pulpotomy: the test is designed for detection of reactions of the pulp and for pulpotomy.

  • Application test of an intra-bone implant: the test is designed for evaluation of materials that are mounted in a bone and penetrate partially the oral mucosa inside the oral cavity.

Conclusions:

The above recommendations of the FDI follow a logical sequence, however, they are not a fixed scheme according to which every dental material should be tested biologically. They are rather guidelines of how and in what order a material should be evaluated. Further modifications and developments are possible in concordance with new findings. Manufacturers of a particular dental product or material should obey this system and follow its rules. For this purpose, a network of testing laboratories should be established in praxis, which would provide for a rational, although official biological testing.

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