The aim of this article was to analyze the theories underpinning dental fear, anxiety and phobias. To be included, articles must have been published between the years of 1949 and 2013 concerning fears and phobias within dentistry and/or psychiatry. Of 200 articles originally under review, 140 were included and reviewed by the authors.Five specific pathways relating to dental fear and anxiety were identified; Cognitive Conditioning, Informative, Visual Vicarious, Verbal Threat, and Parental. Eight currently accepted management techniques across all dental disciplines for dental fear and anxiety were identified. Further research is required to identify clinical diagnosis and treatment for fears originating from different pathways.

Down-regulation of the expression of pro-inflammatory cytokine genes may thus modulate the inflammatory response and may facilitate the enhanced bone wound healing and osseointegration observed clinically using implants with a microrough hydrophilic surface.

With a tube etching process, conical-ended optical fibers for middle infrared lasers that have lateral emissions can be produced, a feature of benefit for delivering laser energy onto the root canal walls. This study examined the ability of these improved laser tips when Er:YAG and Er,Cr:YSGG lasers were used in root canals in which thick smear layers had been created intentionally to provide a challenge for the laser system. Smear layer was assessed from scanning electron microscopy images with an objective digital method. Lasing improved the action of ethylene diamine tetraacetic acid with cetavlon (EDTAC) in removing smear layer. Conical fibers performed better than plain fibers, but there was no difference in performance between the 2 laser systems when matched for all other parameters. These results provide a "proof of concept" for lateral emitting fibers for endodontic procedures and illustrate the novel contribution of lasing to the action of EDTAC in dissolving smear layer.

Virtual reality simulators are becoming an essential part of modern education. The benefits of Virtual reality in dentistry is constantly being assessed as a method or an adjunct to improve fine motor skills, hand-eye coordination in pre-clinical settings and overcome the monetary and intellectual challenges involved with such training. This article, while providing an overview of the virtual reality dental simulators, also looks at the link between virtual reality simulation and current pedagogical knowledge.

Because of the potential for irritant reactions in the periapical region, irrigant solutions must be constrained within the root canal. We examined fluid extrusion beyond the apical constriction by pressure waves generated by pulsed middle infrared lasers using needles and Max-I-Probes (Dentsply) as controls. Both free-running pulsed Erbium: Yttrium Aluminum Garnet (Er:YAG) and Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) lasers with bare or conical fiber tips at distances of 5 or 10 mm from the apex displaced fluid past the apex. Larger apical openings showed greater extrusion of fluid. The volume of extruded fluid was similar to conventional 25-G needles, but fluid was distributed further from the apex. Because pulsed lasers create pressure waves in irrigant fluids within the root canal, the potential for extrusion of fluid from the apex should be considered when assessing intracanal laser treatments in endodontics. (J Endod 2008;34:706 -708) Key WordsApical extrusion, Er,Cr:YSGG laser, Er:YAG laser, optical fibers, root canal I n recent years, there has been increased interest in using pulsed middle infrared lasers (Er:YAG and Er,Cr:YSGG) within the root canal for disinfection (1-4), removing smear layer (5, 6), or for biomechanical preparation (7,8). Water or other irrigants are used during lasing to reduce thermal stress to the radicular dentine and periodontium.These pulsed lasers absorb in water and create pressure waves from explosions followed by implosions. A recent study reported that an Er,Cr;YSGG laser used within the canal with a plain endodontic tip (Biolase Z4; Biolase Technology, Irvine, CA) could generate fluid movement at speeds up to 100 km/h (9). With pressure waves causing such fluid movement, the possibility of accidental extrusion of fluid beyond the apical constriction must be considered. This laboratory study examined fluid extrusion caused by laser pulses using a matrix design to explore relevant variables (including laser type, fiber tip design, distance of the fiber tip from the apex, and size of the apical constriction). Considering the natural variation that occurs between teeth, a repeated-measures design was used so that the same root canal system could undergo multiple treatments. Materials and Methods Sample PreparationA total of 16 recently extracted single-rooted human maxillary anterior teeth that had been collected from older adult periodontal patients undergoing clearances were stored in water saturated with thymol. The teeth comprised 6 maxillary incisors and 10 maxillary canines. All teeth had straight root canals of similar size to reduce effects of canal size and curvature on the extrusion of irrigant. Patency of the apical opening was confirmed with an International Organization for Standardization (ISO) #08 K-file passed in a retrograde manner. After coronal access to the pulp chamber was established using diamond burs, the working length was established by passing a ISO #08 K file to the apex in an anterograde direction and then backing...