Technology today is often seen as the tail wagging the dog. Discoveries or inventions are made, new devices or techniques are developed, and the move to capitalize on them follows immediately. This rush to market is especially evident in the United States, where there is a long-established tradition of investing in technological advances to deal with problems in science and health.

The contrasting cycles of changing caries prevalence in developing and industrialized countries are described, as they relate to differing needs in technology. Using this contrast as a background, the selective needs for technology in measurement, adequate quality of treatment and materials, appropriate personnel, and simplicity and mobility in equipment are discussed.

Toxicity implies an adverse effect. It may be caused by an overdose of any substance or combination of substances, either by an initial high dose or by the accumulation of a toxic substance over a long period of time. Thus, toxicity is dose dependent. It is also a relative term in that therisk involved must be evaluated and the available alternatives assessed.

This article reviews the development, composition, chemistry, recent technological advances, and extent of use of composite resin restorative materials, adhesives, and pit and fissure sealants. The problems related to the clinical behavior of these materials in the oral environment are dealt with, and methods of minimizing their present deficiencies are suggested. Future directions that might be taken to improve these materials and solve some of the inadequacies that these materials exhibit are also discussed.

The dramatic decrease in dental caries among children in the United States has been well documented and widely reported. In the early 1970s, only approximately 28% of children were free of dental caries; by 1980, this figure increased to 36.6% (53). The most recent national survey results reported by the National Institute of Dental Research found approximately 50% of all school children to be free of caries (50).

The various treatments for periodontal disease must be assessed in light of the recently articulated goals of periodontal therapy to preserve teeth for a lifetime and to enhance esthetics and comfort as well as oral health. This article examines the long-term comparisons of periodontal surgery, curettage, and scaling and root planing in improving attachment levels instead of the more traditional pocket depth.

The traditional approach to treating dental decay and periodontal disease has often focused on caries, neglecting periodontal infection. The past 15 years have seen significant advances in the treatment of periodontal disease with antimicrobial therapy, both with and without moretraditional debridement or surgery. This article presents an overview of the use of antimicrobials, including an examination of treatment philosophies and the diagnosis of periodontal infection.

Fifty-three deaf patients were screened psychologically and medically for suitability to receive an intracochlear implant. After initial screening for psychological normalcy, candidates were assessed again 1 year postimplant. Isolated deleterious psychological effects were found, and certain aspects of psychological functioning were enhanced. Overall evidence suggests that the implant is not psychologically damaging.

Until now, no systematic strategy for the prevention of major hemoglobinopathies has been implemented in southeastern France, in spite of frequencies of β-thalassemia trait and HbS trait as high as 2·5–8% in some ethnic populations. The purpose of the study was to help a group of experts, brought together by the Regional Center for Disease Control, to reach a consensus about screening for carriers of heterozygote hemoglobinopathies. A multicriteria decision-analysis model was used to take into account not only the costs and effectiveness of potential screening strategies, but also five other qualitative criteria: technical and practical feasibilities, ethical acceptability, information follow-up in time, and global impact on health education. Conclusions differ significatively from those of a pure costeffectiveness analysis, but a multicriteria approach seems best suited to medical experts' preferences.

The consensus development conference method developed by the National Institutes of Health in the United States has been adopted and modified by a number of countries. Based on published articles and communication with representatives from each country, we examined whether the organization and conduct of these conferences in nine countries (United States, Canada, Denmark, Finland, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom) enhanced or detracted from achieving the stated conference goals and objectives. We conclude that improvements in the process by which consensus conferences are conducted may be warranted. More scientific methods for synthesizing literature, such as meta-analysis, should be used in developing inputs for the conference panel. Formalizing the decision-making processes through polling or other methods that allow for structured disagreement with parts of a consensus statement would potentially expand the range and type of issues that can be addressed in such conferences. Finally, countries should consider having the consensus statement written over a longer period of time than the traditional overnight session, which seems unlikely to promote clear thinking.

While subcutaneous heparin is a standard prophylaxis for death from pulmonary embolism following general surgery, it has been suggested that adding the vasoconstricting drug dihydroergotamine would improve survival compared to heparin alone. Dihydroergotamine may be associated with rare but life-threatening side effects; thus, reduced mortality from pulmonary embolism could be offset by increased mortality from other causes. Because a clinical trial to examine this possibility would be impractical, we performed a cost-effectiveness analysis to evaluate the effects of prophylactic dihydroergotamine on mortality. Based on published data, despite its favorable effects on the prevention of deep vein thrombosis, the addition of dihydroergotamine did not appear to save lives when added to heparin as prophylaxis. Probabilistic sensitivity analysis demonstrated that even if published risk estimates are in error, substantial changes would still not support the conclusion that dihydroergotamine is lifesaving. In the absence of clear potential for improved survival, the increased costs associated with dihydroergotamine provide reason to question its routine prophylactic use in general surgery.

The National Institutes of Health (NIH) is periodically asked to conduct assessments of new medical technologies to assist in coverage decisions made at the Office of Health Technology Assessment (OHTA) for the Health Care Financing Administration coverage policy. Analysis of NIH assessments indicates that even though most NIH assessments rely only on expert opinion, OHTA agreed with NIH recommendaations in over 90%.