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Restricted acts and protected titles
Published in Michael Weir, Law and Ethics in Complementary Medicine, 2023
One query might arise in relation to restricted activity no. 1 in relation to acupuncture, which will involve insertion of acupuncture needles below the surface of the skin. The reference to ‘surgical or operative procedures’ would seem to suggest that acupuncture does not breach this provision. The Guidelines for the Operation of Restricted Activities under the Health Practitioners Competence Assurance Act 2003 state with regard to restricted activity no. 125: This is intended to broadly capture activities that involve cutting the flesh or doing something that causes bleeding. Particular reference is made to teeth and to the gingival margin (the ‘gum’). [NB In many cases, evidence of bleeding will give rise to a presumption of an offence. The Ministry would take note of the occurrence of blood or bleeding as a result of actions taken by non-registered individuals when considering if a breach of this restricted activity has occurred. If it appears that a breach has occurred, the occurrence of blood/bleeding will be taken as evidence of a breach of this restricted activity].
Stainless Steel Crowns for Primary Molars
Published in M S Duggal, M E J Curzon, S A Fayle, K J Toumba, A J Robertson, Restorative Techniques in Paediatric Dentistry, 2021
M S Duggal, M E J Curzon, S A Fayle, K J Toumba, A J Robertson
Local analgesia should be administered, although it may not always be necessary when preparing a tooth that has undergone pulp therapy. Nevertheless, even in these teeth there will need to be some preparation involving the gingival margin, which can cause some discomfort. Rubber dam should also be used. Because the preparation for a crown is usually carried out at the same visit as the pulp therapy, local analgesia and rubber dam are already in place. When the stainless steel crown is fitted for extensive caries or for some other reason, rubber dam is required. Wherever possible, the rubber dam clamp should be placed on the tooth distal to the one being restored. However, difficulty arises if the tooth that needs clamping is the tooth being prepared for the crown (Figure 5.12), the proximal reduction distally becoming difficult because the bur will be caught in the rubber dam sheet. In these instances it is recommended that all necessary reduction, except the distal proximal slice, be carried out under rubber dam. The dam is then removed, the distal slice completed and the crown fitted without the dam. Alternatively, the rubber dam can be held clear of the distal surface by the dental surgery assistant with a flat plastic instrument while the distal surface is being reduced as shown in Figure 5.31. Note in Figure 5.12 that the rubber dam is placed using the trough method, described in Chapter 3, which gives access to the mesial surface for reduction.
Factors Controlling the Microflora of the Healthy Mouth
Published in Michael J. Hill, Philip D. Marsh, Human Microbial Ecology, 2020
The junction between tooth and gingiva (gum) is a unique habitat (Figures 2, 4, 8 and 17), and a great diversity of species is found in supragingival plaque (located immediately above the gingival margin) as well as in subgingival plaque (below the margin, in the gingival crevice and periodontal pocket). In the absence of adequate oral hygiene, dental plaque accumulates in this protected area and invariably causes gingivitis (inflammation of the gum) (Figure 4).16 The inflammatory exudate (gingival crevicular fluid) associated with gingivitis, together with intermicrobial food webs (see below), supplies nutrients for fastidious bacteria unable to grow elsewhere in the mouth. Streptococcus, Actinomyces, Bacteroides, and Veillonella are the major genera found in plaque in the gingival region (Figure 15). Here, however, Gram-negative rods make up about 40% of the bacteria and include many Bacteroides species and other anaerobes such as Fusobacterium, Leptotrichia, Wolinella, and Selenomonas species. Gram-negative, facultatively anaerobic rods are also present, such as Haemophilus, Capnocytophaga, Eikenella, and Actinobacillus. Furthermore, Gram-positive anaerobes constitute high proportions, notably Peptostreptococcus spp., A. israelii, and Eubacterium species. Treponema species not found elsewhere are also present (Figure 23).1718, 122, 123
Effects of fixed retainers on gingival recession – a 10-year retrospective study
Published in Acta Odontologica Scandinavica, 2023
Roxana Khalil, Java Walladbegi, Anna Westerlund
Patient records were screened for orthodontic treatments with fixed appliances and follow-up of fixed retainers in the period 1995 − 2003. For the control group, new study casts were prepared using alginate (Blueprint Xcreme) impressions with metallic trays. Intraoral images were acquired using a system camera (Canon Powershot G7X). Gingival recessions were measured in the anterior segment, i.e. canine to canine, for the upper-, and lower jaws respectively, using intraoral photographs of the anterior segment and study casts. Gingival recessions were measured in millimetres (mm) from the gingival margin on the mid-buccal surfaces to the cemento–enamel junction. The calibration of the intraoral photographs was done with the ratio of the mid-buccal length for tooth 21 from gingival margin to incisal edge measured on photograph and study cast, respectively.
Sex-specific reference values for the crown heights of permanent anterior teeth and canines for assessing tooth wear
Published in Acta Odontologica Scandinavica, 2023
Paula Roca-Obis, Ona Rius-Bonet, Carla Zamora-Olave, Eva Willaert, Jordi Martinez-Gomis
It is important that the reference values in this study were obtained using a clinical protocol. Moreover, the main advantages of using the gingival margin instead of the CEJ as the reference point are that it is more comfortable for the patient and easier for the clinician to locate. It also allows a calliper to be used for measurement, which is more sensitive than a periodontal probe for measuring anterior intraoral distances. An inconvenience of using the gingival margin is that the location can vary with gingival inflammation or overgrowth. In cases of incisal recession or periodontal surgery where the CEJ may be visible, this could be used as a reference point for the calliper. Other studies measuring clinical crown height from the gingival margin to the incisal edge with a digital calliper have reported data with differences of less than 1 mm [17,18].
Approximal plaque pH lowering after sugar intake in a periodontally infected dentition
Published in Acta Odontologica Scandinavica, 2021
The pH strip method was used as previously described [20], however slightly modified as the pH was measured at a distance from the gingival margin directly below the contact point (see Figure 1). This location was chosen since plaque is formed during relative seclusion and the changing imbalance of bacterial acid production and alkaline GCF components from the gingival margin was believed to be the least exposed to disturbing influences. Further on, this location was – in relation to the gingival margin – considered to be the least affected by possibly changing dimensions of the soft tissues after periodontal surgery. We used two types of pH indicator strips (range 4–7 and 6.5–10; MQuant®; Merck KGaA; Darmstadt, Germany) not to miss values in the alkaline range. The original strips were cut into three pieces (ca. 2 mm in width), which were easy to insert directly under the contact point in the interdental space.