Cork University Dental School and Hospital - Journal Articles

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Adhesives for bonded molar tubes during fixed brace treatment
(John Wiley & Sons, Inc., 2017-02-23) Millett, Declan T.; Mandall, Nicky A.; Mattick, Rye C. R.; Hickman, Joy; Glenny, Anne-Marie; National Institute for Health Research; Cochrane Oral Health Global Alliance, United Kingdom
Background: Orthodontic treatment involves using fixed or removable appliances (dental braces) to correct the positions of teeth. The success of a fixed appliance depends partly on the metal attachments (brackets and bands) being glued to the teeth so that they do not become detached during treatment. Brackets (metal squares) are usually attached to teeth other than molars, where bands (metal rings that go round each tooth) are more commonly used. Orthodontic tubes (stainless steel tubes that allow wires to pass through them), are typically welded to bands but they may also be glued directly (bonded) to molars. Failure of brackets, bands and bonded molar tubes slows down the progress of treatment with a fixed appliance. It can also be costly in terms of clinical time, materials and time lost from education/work for the patient. This is an update of the Cochrane review first published in 2011. A new full search was conducted on 15 February 2017 but no new studies were identified. We have only updated the search methods section in this new version. The conclusions of this Cochrane review remain the same. Objectives: To evaluate the effectiveness of the adhesives used to attach bonded molar tubes, and the relative effectiveness of the adhesives used to attach bonded molar tubes versus adhesives used to attach bands, during fixed appliance treatment, in terms of: (1) how often the tubes (or bands) come off during treatment; and (2) whether they protect the bonded (or banded) teeth against decay. Search methods: The following electronic databases were searched: Cochrane Oral Health's Trials Register (to 15 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1) in the Cochrane Library (searched 15 February 2017), MEDLINE Ovid (1946 to 15 February 2017), and Embase Ovid (1980 to 15 February 2017). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: Randomised controlled trials of participants with full arch fixed orthodontic appliance(s) with molar tubes, bonded to first or second permanent molars. Trials which compared any type of adhesive used to bond molar tubes (stainless steel or titanium) with any other adhesive, were included. Trials were also included where: (1) a tube was bonded to a molar tooth on one side of an arch and a band cemented to the same tooth type on the opposite side of the same arch; (2) molar tubes had been allocated to one tooth type in one patient group and molar bands to the same tooth type in another patient group. Data collection and analysis: The selection of papers, decision about eligibility and data extraction were carried out independently and in duplicate without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. Main results: Two trials (n = 190), at low risk of bias, were included in the review and both presented data on first time failure at the tooth level. Pooling of the data showed a statistically significant difference in favour of molar bands, with a hazard ratio of 2.92 (95% confidence intervals (CI) 1.80 to 4.72). No statistically significant heterogeneity was shown between the two studies. Data on first time failure at the patient level were also available and showed statistically different difference in favour of molar bands (risk ratio 2.30; 95% CI 1.56 to 3.41) (risk of event for molar tubes = 57%; risk of event for molar bands 25%). One trial presented data on decalcification again showing a statistically significant difference in favour of molar bands. No other adverse events identified. Authors' conclusions: From the two well-designed and low risk of bias trials included in this review it was shown that the failure of molar tubes bonded with either a chemically-cured or light-cured adhesive was considerably higher than that of molar bands cemented with glass ionomer cement. One trial indicated that there was less decalcification with molar bands cemented with glass ionomer cement than with bonded molar tubes cemented with a light-cured adhesive. However, given there are limited data for this outcome, further evidence is required to draw more robust conclusions.
Adhesives for fixed orthodontic bands
(John Wiley & Sons, Ltd., 2016-10) Millett, Declan T.; Glenny, Anne-Marie; Mattick, Rye C.R.; Hickman, Joy; Mandall, Nicky A.
Background: Orthodontic treatment involves using fixed or removable appliances (dental braces) to correct the positions of teeth. It has been shown that the quality of treatment result obtained with fixed appliances is much better than with removable appliances. Fixed appliances are, therefore, favoured by most orthodontists for treatment. The success of a fixed orthodontic appliance depends on the metal attachments (brackets and bands) being attached securely to the teeth so that they do not become loose during treatment. Brackets are usually attached to the front and side teeth, whereas bands (metal rings that go round the teeth) are more commonly used on the back teeth (molars). A number of adhesives are available to attach bands to teeth and it is important to understand which group of adhesives bond most reliably, as well as reducing or preventing dental decay during the treatment period. :Objectives: To evaluate the effectiveness of the adhesives used to attach bands to teeth during fixed appliance treatment, in terms of: (1) how often the bands come off during treatment; and (2) whether they protect the banded teeth against decay during fixed appliance treatment. Search methods: The following electronic databases were searched: Cochrane Oral Health's Trials Register (searched 2 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5) in the Cochrane Library (searched 2 June 2016), MEDLINE Ovid (1946 to 2 June 2016) and EMBASE Ovid (1980 to 2 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: Randomised and controlled clinical trials (RCTs and CCTs) (including split-mouth studies) of adhesives used to attach orthodontic bands to molar teeth were selected. Patients with full arch fixed orthodontic appliance(s) who had bands attached to molars were included. Data collection and analysis: All review authors were involved in study selection, validity assessment and data extraction without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. Main results: Five RCTs and three CCTs were identified as meeting the review's inclusion criteria. All the included trials were of split-mouth design. Four trials compared chemically cured zinc phosphate and chemically cured glass ionomer; three trials compared chemically cured glass ionomer cement with light cured compomer; one trial compared chemically cured glass ionomer with a chemically cured glass phosphonate. Data analysis was often inappropriate within the studies meeting the inclusion criteria. Authors' conclusions: There is insufficient high quality evidence with regard to the most effective adhesive for attaching orthodontic bands to molar teeth. Further RCTs are required.
An analysis of the attitudes of dental patients attending general dental practice in Galway
(Irish Dental Association, 2013-08) Hayes, Martina; Burke, Francis M.; McKenna, Gerald; Madden, Jamie M.; Cronin, Michael
Aim: To describe the patterns of dental attendance and attitudes towards tooth loss of general dental practice patients in Galway. Objectives: 1. To determine the pattern of adult dental attendance in general practices in Galway; and, 2. To examine the oral health attitudes of these patients. Method: Questionnaires were distributed to 311 consecutive adult patients in the waiting rooms of ten general dental practices in Galway, which were randomly selected from the telephone directory. Results: A total of 254 of the 311 questionnaires distributed were fully completed, returned and included in the results, giving a response rate of 81.7%. A total of 59% of dentate participants attended their dentist for annual or biannual examinations compared to 23% of edentate patients. Some 10.5% of medical card holders and 0.5% of non-medical card holders were edentulous. Conclusions: The data from the survey indicated that medical card holders in Galway were more likely to be edentulous than nonmedical card holders. Edentate patients were less likely to be regular dental attenders than dentate patients.
Assessing periodontal health and the British Society of Periodontology implementation of the New Classification of Periodontal Diseases 2017
(George Warman Publications, 2019-11) Milward, Mike; Roberts, Anthony
Periodontal disease is a highly prevalent, chronic, inflammatory condition which is a major contributor to tooth loss and poor oral health-related quality of life. For the vast majority of patients, the disease is entirely preventable/manageable often aided by input from dental health professionals. As dental health professionals, understanding the periodontal disease process, the risk factors associated with it, standardized ways of detecting, diagnosing and monitoring the disease, along with the special tests needed to aid this process are essential skills for successful disease management. This article summarizes the need for assessing periodontal disease including key aspects of detection, a brief history of periodontal disease classification and the new classification. The paper goes on to discuss the British Society of Periodontology implementation plan of new classification and how this can be utilized for use in general dental practice. CPD/Clinical Relevance: This paper introduces the practitioner to the 2017 Classification of Periodontal Disease along with how this is implemented in general dental practice. The paper provides useful cases for practice as well as flowcharts to aid diagnosis.
Brief communication: Dentists' reproducibility in scoring the Plaque Index using a fluorescent colouring agent
(Irish Dental Association, 2017-08) Nishi, Makiko; Roberts, Anthony; Harding, Máiréad; Allen, P. Finbarr
Statement of the problem: Fluorescein is a plaque detection agent, which fluoresces yellow-green when excited with blue light (dental light curing lamp). Little is known about the reproducibility of scoring with the Silness-Löe plaque index (1964) when using this agent. Purpose of the study: To evaluate the level of agreement of the plaque index measurements using a fluorescent colouring agent among eight dentists. Materials and methods: Eight dentists in Cork were recruited as examiners for a randomised clinical study investigating the impact of a personalised caries prevention approach. They were trained and calibrated in the use of the plaque index using Plaque Test (Ivoclar Vivadent, Liechtenstein) in the Oral Health Services Research Centre and School of Dental Hygiene, University College Cork. For inter-examiner and intra-examiner reproducibility, a previously calibrated ‘gold standard’ examiner and seven dentists examined 10 to 12 subjects each, while one dentist examined four subjects only for inter-examiner reproducibility. The adult subjects were recruited at the Cork University Dental School and Hospital. To evaluate inter-examiner and intra-examiner reproducibility at site level, squared weighted kappa statistics were calculated. Results: The weighted kappa statistics varied from 0.31 to 0.54 for inter-examiner reproducibility under the acceptable level (kappa statistics = 0.60) for research purposes and from 0.43 to 0.65 for intra-examiner reproducibility. Conclusions: The levels of agreement were fair to good. Further studies are needed, preferably including a qualitative study to analyse feedback from dentists to determine the cause of such variation. This study re-emphasises the importance of clinician calibration ahead of clinical studies.
Brief report: analysis of dental treatment provided under general anaesthesia for children and young adults with autistic spectrum disorder and identification of challenges for dental services
(Springer, 2021-02-08) Parry, Jennifer Ann; Brosnan, Sinead; Newton, J. Tim; Linehan, Conor; Ryan, Christian
Dental treatment provided under general anaesthesia (DGA) is an expectation for many children and young adults (CYA) diagnosed with Autistic Spectrum Disorder (ASD). Planning and delivery of DGA requires consideration of morbidity and mortality risks and implications for families and healthcare services. One hundred patient records of CYA with special healthcare needs were analysed to examine characteristics and experience of DGA revealing that 79% of CYA had a diagnosis of ASD. Forty-seven percent of CYA diagnosed with ASD had at least one previous hospital admission for DGA. For 24% of this repeat DGA group, the previous DGA was within a two-year period. Results highlight a high rate of DGA and need to investigate more effective primary dental care strategies.
Calcifying odontogenic cyst: a case report
(Wiley, 2020-01-29) Mulvihill, Ciara; Ní Mhaolcatha, Sarah; Brady, Paul; McKenna, Jill E.; Sleeman, Duncan; Fitzgibbon, James
A calcifying odontogenic cyst (COC) is a rare odontogenic lesion with a vast variety of clinical, radiological, histopathological features and biological behaviours. In this article, we illustrate a case of an 18‐year‐old male patient with a complaint of an 18‐month history of swelling in his right maxilla. The lesion was diagnosed as a COC associated with an impacted 18 using radiological, cytological and histopathological investigations. The present study examines and considers the case.
Cancer-related financial hardship among head and neck cancer survivors: risk factors and associations with health-related quality of life
(Wiley, 2019-02-19) Lu, Liya; O'Sullivan, Eleanor; Sharp, Linda; Health Research Board
Objective: Cancer survivors are susceptible to financial hardship. In head and neck cancer (HNC) survivors, we investigated (a) predictors for cancer‐related financial hardship and (b) associations between financial hardship and health‐related quality of life (HRQoL). Methods: We conducted a cross‐sectional study in HNC survivors identified from the National Cancer Registry Ireland. HRQoL was based on the Functional Assessment for Cancer Therapy General (FACT‐G) plus Head and Neck Module (FACT‐HN). Objective cancer‐related financial hardship (financial stress) was assessed as household ability to make ends meet due to cancer and subjective financial hardship (financial strain) as feelings about household financial situation due to cancer. Modified Poisson regression was used to identify predictors for financial hardship. Bootstrap linear regression was used to estimate associations between hardship and FACT domain scores. Results: Pre‐diagnosis retirement (relative risk [RR] 0.50, 95% confidence interval [CI] 0.37‐0.67), pre‐diagnosis financial stress (RR 1.85, 95% CI 1.58‐2.15), and treatment were significantly associated with objective financial hardship. Predictors of subjective financial hardship were similar: aged greater than or equal to 65 years, pre‐diagnosis financial stress, and treatment. Participants with objective financial hardship reported significantly lower physical (coefficient −3.45, 95% CI −4.39 to −2.44), emotional (−2.01, 95% CI −2.83 to −1.24), functional (−2.56, 95% CI −3.77 to −1.33) and HN‐specific HRQoL (−3.55, 95% CI −5.04 to −2.23). Physical, emotional, and functional HN‐specific HRQoL were also significantly lower in participants with subjective financial hardship. Conclusion: Cancer‐related financial hardship is common and associated with worse HRQoL among HNC survivors. This supports the need for services and supports to address financial concerns among HNC survivors.
Caries prevention for older people
(Connect Publications, 2012-09) Hayes, Martina
Characteristics of wastewater originating from dental practices using predominantly mercury-free dental materials
(Elsevier B.V., 2022-01-07) Binner, Hannah; Kamali, N.; Harding, Mairead; Sullivan, Timothy; Environmental Protection Agency; Department of Communication, Climate Action and Environment, Ireland
Dental materials are currently undergoing a revolution. Mercury use, including traditional amalgam (mercury-containing) material used in dental fillings, is now being widely regulated under the Minamata convention, and dental amalgam is currently being replaced by resin formulations in dentistry. These resin-based materials can be tuned to offer varying material properties by incorporation of a range of nano- and micro-particle based 'fillers' for different dental properties and applications. However, these innovations may have a concomitant effect on the waste streams associated with common dental applications, in particular the potential for higher concentrations of novel micro- and nanomaterials within wastewater streams, and a potential route for novel nanomaterials into the wider Environment. These new materials may also mean that wastewater filtering apparatus commonly deployed at present, such as amalgam separators, may be less efficient or insufficient to capture these new filler materials in dental facility wastewater. In this work, we analyse dental wastewater streams from three dental facilities in Ireland with differing amalgam separators in place. The potential overall toxicity, particulate load and physicochemical properties are analysed. The overall risk posed by these new materials is also discussed.
Chlorhexidine mouthwash as an adjunctive treatment for gingival health
(John Wiley & Sons, Ltd., 2017-03-31) James, Patrice; Worthington, Helen V.; Parnell, Carmel; Harding, Máiréad; Lamont, Thomas; Cheung, Andrea; Whelton, Helen; Riley, Philip; Health Research Board; National Institute for Health Research; Cochrane Oral Health Global Alliance, United Kingdom
Background: Dental plaque associated gingivitis is a reversible inflammatory condition caused by accumulation and persistence of microbial biofilms (dental plaque) on the teeth. It is characterised by redness and swelling of the gingivae (gums) and a tendency for the gingivae to bleed easily. In susceptible individuals, gingivitis may lead to periodontitis and loss of the soft tissue and bony support for the tooth. It is thought that chlorhexidine mouthrinse may reduce the build-up of plaque thereby reducing gingivitis. Objectives: To assess the effectiveness of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for the control of gingivitis and plaque compared to mechanical oral hygiene procedures alone or mechanical oral hygiene procedures plus placebo/control mouthrinse. Mechanical oral hygiene procedures were toothbrushing with/without the use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. To determine whether the effect of chlorhexidine mouthrinse is influenced by chlorhexidine concentration, or frequency of rinsing (once/day versus twice/day). To report and describe any adverse effects associated with chlorhexidine mouthrinse use from included trials. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 28 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 28 September 2016); MEDLINE Ovid (1946 to 28 September 2016); Embase Ovid (1980 to 28 September 2016); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 28 September 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: We included randomised controlled trials assessing the effects of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for at least 4 weeks on gingivitis in children and adults. Mechanical oral hygiene procedures were toothbrushing with/without use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. We included trials where participants had gingivitis or periodontitis, where participants were healthy and where some or all participants had medical conditions or special care needs. Data collection and analysis: Two review authors independently screened the search results extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference (MD) and 95% confidence interval (CI). We combined MDs where studies used the same scale and standardised mean differences (SMDs) where studies used different scales. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. Due to anticipated heterogeneity we used random-effects models for all meta-analyses. Main results: We included 51 studies that analysed a total of 5345 participants. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however, this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Gingivitis: After 4 to 6 weeks of use, chlorhexidine mouthrinse reduced gingivitis (Gingival Index (GI) 0 to 3 scale) by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse (10 trials, 805 participants with mild gingival inflammation (mean score 1 on the GI scale) analysed, high-quality evidence). A similar effect size was found for reducing gingivitis at 6 months. There were insufficient data to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 (moderate or severe levels of gingival inflammation). Plaque: Plaque was measured by different indices and the SMD at 4 to 6 weeks was 1.45 (95% CI 1.00 to 1.90) standard deviations lower in the chlorhexidine group (12 trials, 950 participants analysed, high-quality evidence), indicating a large reduction in plaque. A similar large reduction was found for chlorhexidine mouthrinse use at 6 months. Extrinsic tooth staining: There was a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 4 to 6 weeks. The SMD was 1.07 (95% CI 0.80 to 1.34) standard deviations higher (eight trials, 415 participants analysed, moderate-quality evidence) in the chlorhexidine mouthrinse group. There was also a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 7 to 12 weeks and 6 months. Calculus: Results for the effect of chlorhexidine mouthrinse on calculus formation were inconclusive. Effect of concentration and frequency of rinsing There were insufficient data to determine whether there was a difference in effect for either chlorhexidine concentration or frequency of rinsing. Other adverse effects: The adverse effects most commonly reported in the included studies were taste disturbance/alteration (reported in 11 studies), effects on the oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions (reported in 13 studies) and a general burning sensation or a burning tongue or both (reported in nine studies). Authors' conclusions: There is high-quality evidence from studies that reported the LÃ¶e and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies.
Clinical governance: a friend or foe to dental care practice in the UK?
(Public Knowledge Project, 2017-03) Snowden, Michael; Ellwood, Fiona; McSherry, Rob; Halsall, Jamie P.; Hough, Donna; National Health Service, United Kingdom
This paper presents a literature review of clinical governance and its impact upon dental health care in the UK. Whilst the value of clinical governance is recognised, the findings illustrate that the concept of clinical governance remains challenging to dental care practitioners, illustrated by lack of knowledge and confidence in its application and evaluation. The study also identifies a distinct paucity of research concerning impact and makes recommendations to enhance clinical governance in practice.
Comparison of the salivary and dentinal microbiome of children with severe-early childhood caries to the salivary microbiome of caries-free children
(BioMed Central, 2019) Hurley, Eimear; Barrett, Maurice P. J.; Kinirons, Martin; Whelton, Helen; Ryan, C. Anthony; Stanton, Catherine; Harris, Hugh M. B.; O'Toole, Paul W.; Health Research Board
The main objectives of this study were to describe and compare the microbiota of 1) deep dentinal lesions of deciduous teeth of children affected with severe early childhood caries (S-ECC) and 2) the unstimulated saliva of these children and 3) the unstimulated saliva of caries-free children, and to compare microbiota compositional differences and diversity of taxa in these sampled sites.
Consumption frequency of added sugars and UK children's dental caries
(John Wiley & Sons, Inc., 2018-08-20) Hong, Jialan; Whelton, Helen; Douglas, Gail; Kang, Jing
Objectives: To examine the association between consumption frequency of foods and drinks with added sugar and dental caries experience in the permanent teeth of 12- and 15-year-old children in England, Wales and Northern Ireland, using the Children's Dental Health Survey 2013 (CDHS) data. Methods: Four thousand nine hundred and fifty children aged 12 and 15 have the following information available: daily consumption frequency of foods and drinks with added sugar, tooth-brushing frequency, dental attendance, and water-drinking frequency. The children's dental caries experience was available as a DMFT score (number of decayed, missing, filled permanent teeth). A zero-inflated negative binomial model (ZINB) was used to fit the DMFT score. Results: Lower socioeconomic status (SES), nonregular dental check-ups, and low water-drinking frequency were associated with higher consumption frequency of added sugar (all P < 0.05). The consumption frequency of both drinks and foods with added sugar also differed by region (P < 0.001), and children who more frequently consumed foods with added sugars also consumed drinks with added sugars more often (P < 0.001). Using the Zero-Inflated Negative Binomial model, DMFT scores were not associated with consumption frequency of added sugars for children with caries (DMFT > 0), but the chance of being free of obvious caries (DMFT = 0) was lower for children with high frequency (≥4) of sugar-added foods than for children reported to have a sugar-free diet (OR = 0.5, 95% CI [0.3, 0.8]). Conclusions: Consumption frequency of added sugars was associated with dental caries and a number of child demographic and lifestyle characteristics. Children who consume foods and drinks with added sugar more frequently are more likely to develop dental caries, but higher consumption frequency of drinking water in fluoridated areas might reduce dental caries. The findings add to the evidence for the association between children's dental caries and added sugar consumption.
Contemporary teaching of restoration repair at dental schools in Germany - Close to universality and consistency
(Elsevier Ltd., 2018-06-19) Kanzow, Philipp; Wiegand, Annette; Wilson, Nairn H. F.; Lynch, Christopher D.; Blum, Igor R.
Objectives: To identify potential changes in various aspects of teaching and to ascertain whether previously found inconsistencies in the teaching of criteria, indications and operative techniques for the repair of defective composite restorations at German dental schools have been resolved. Methods: A validated questionnaire was used to gain the information sought. It was sent to all dental schools in Germany (n = 30). Whenever possible, data were compared to previous studies conducted in 2000 and 2009. Statistical analysis was performed using Fisher’s exact tests (p < 0.05). Results: Twenty-nine schools responded to the survey – a response rate of 97%. All respondents indicated positive experiences with the repair of restorations. The teaching of repairs in 2018 (90%) was found to be comparable to the findings from the 2009 survey (88%, p = 1.000), but significantly increased since the 2000 survey (50%, p = 0.006). Main reasons reported for teaching repairs are tooth substance preservation (97%) and reduction of pulpal damage (79%). Main clinical indications are marginal defects and secondary caries. When performing repairs, almost all dental schools were found to teach both mechanical and adhesive substrate surface conditioning. Marked variation was observed in the method of mechanical surface treatment, with air abrasion having gained widespread popularity. The average expected longevity of repairs was 7.4 ± 3.0 years. Conclusions: The teaching of the repair of resin composite restorations is widespread in dental schools in Germany. Aspects of this teaching were found to be more consistent between dental schools than in previous surveys, albeit variation in operative techniques still exists. Clinical significance: Graduates from dental schools in Germany may be found to be well equipped with the knowledge and skills to perform repairs of defective resin based composite restorations in clinical practice.
Current uses of chlorhexidine for management of oral disease: a narrative review
(Elsevier B.V., 2020-10-17) Brookes, Zoe L. S.; Bescos, Raul; Belfield, Louise A.; Ali, Kamran; Roberts, Anthony
Objectives: Chlorhexidine (CHX) is a commonly used antiseptic mouthwash, used by dental practitioners and the public, due to its antimicrobial effects. The aim of this article was to provide a narrative review of current antimicrobial uses of CHX relevant to dentistry in the context of oral diseases, highlighting need for further studies to support its safe and appropriate use. Study selection, data and sources: Randomised controlled trials, systematic reviews and national (UK and US) guidelines were consulted where available, with search terms for each subject category entered into MEDLINE, PubMed, Google Scholar and the Cochrane database. Results: Some evidence existed to support adjunctive short-term use of CHX to manage dental plaque, and reduce clinical symptoms of gingivitis, dry socket, as well as reduce aerosolisation of bacteria. However, use must be weighed alongside the less desirable effects of CHX, including extrinsic staining of teeth, antimicrobial resistance to antiseptic agents and the rare, but fatal, allergic reactions to CHX. Conversely, evidence for the effectiveness of chlorhexidine to manage or prevent periodontitis, dental caries, necrotising periodontal diseases, peri-implantitis, and infections associated with extraction and aerosolised viruses remains less certain. Conclusions: The use of CHX in dentistry and oral healthcare continues to be widespread and thus it is important that dental practitioners understand that, based on its differential mechanisms of action on different microbes, appropriate clinical and dental use of CHX should be oral disease specific. However, further scientific and clinical research is required before full recommendations can be made.
Decisions on repositioning of intruded permanent incisors; A review and case presentation
(European Journal of Paediatric Dentistry, 2018) Hurley, Eimear; Stewart, Christopher J.; Gallagher, Christine; Kinirons, Martin J.
Background: Traumatic intrusion is a luxation type of injury where the tooth is displaced along the axis of the tooth, into the alveolus. This injury is regarded as serious because of the tissue damage that it causes. The traumatic movement is associated with severe damage to the periodontal ligament, pulpal tissue, root and alveolar socket. Despite its severity, the rare occurrence of this injury in permanent teeth has resulted in limited studies of immature and mature permanent incisors. The purpose of this paper is to review this luxation injury of permanent immature incisors, and to describe its diagnosis, treatment and management. In particular, we describe the repositioning strategies used in cases of intrusion injury. These include (i) monitoring spontaneous re-eruption, (ii) active orthodontic repositioning and (iii) surgical repositioning. Firstly, monitoring spontaneous re-eruption is observing and waiting for the intruded tooth to return to its original position. This process is not a normal developmental eruption and the outcome is not always predictable, nor is the time needed for this to happen. Secondly, active orthodontic repositioning is used to describe the process of rapidly moving the intruded tooth to its original position with the aid of an orthodontic appliance. Active orthodontic repositioning is often misunderstood as normal orthodontic movement. Orthodontic movement allows for periodontal ligament remodelling, using light intermittent forces. In contrast the active orthodontic repositioning used to move intruded incisors is rapid, and the primary aim is to achieve correct tooth position as rapidly as possible. Thirdly, surgical repositioning uses surgical intervention to bring the tooth back to its original position. A case of an intruded immature permanent incisor is presented, with a particular emphasis on these critical decisions on repositioning and showing the use of the three modalities of treatment in sequence, in order to achieve an outcome.
Dementia in older people admitted to hospital: an analysis of length of stay and associated costs
(John Wiley & Sons, Inc., 2018-09-24) Ahern, Susan; Cronin, Jodi; Woods, Noel; Brady, Noeleen M.; O'Regan, Niamh A.; Trawley, Steven; Timmons, Suzanne; Health Research Board
Objectives: Patients with dementia in the acute setting are generally considered to impose higher costs on the health system compared to those without the disease largely due to longer length of stay (LOS). Many studies exploring the economic impact of the disease extrapolate estimates based on the costs of patients diagnosed using routinely collected hospital discharge data only. However, much dementia is undiagnosed, and therefore in limiting the analysis to this cohort, we believe that LOS and the associated costs of dementia may be overestimated. We examined LOS and associated costs in a cohort of patients specifically screened for dementia in the hospital setting. Methods: Using primary data collected from a prospective observational study of patients aged≥70 years, we conducted a comparative analysis of LOS and associated hospital costs for patients with and without a diagnosis of dementia. Results: There was no significant difference in overall length of stay and total costs between those with (μ= 9.9 days, μ=€8246) and without (μ= 8.25 days, μ=€6855) dementia. Categorical data analysis of LOS and costs between the two groups provided mixed results. Conclusions: The results challenge the basis for estimating the costs of dementia in the acute setting using LOS data from only those patients with a formal dementia diagnosis identified by routinely collected hospital discharge data. Accurate disease prevalence data, encompassing all stages of disease severity, are required to enable an estimation of the true costs of dementia in the acute setting based on LOS.
Dental anxiety prevalence and surgery environment factors: A questionnaire-based survey of attenders in Ireland
(Society for the Advancement of Anaesthesia in Dentistry, 2012-01) Brady, Paul; Dickinson, Chris; Whelton, Helen
Aim: To identify and quantify anxious dental patientsand dental office environment factors that may influence anxiety. Objective: To develop and implement a questionnaire toinvestigate dental anxiety and identify factors thatenhance or lessen dental anxiety in the surgery setting. Methods: Data was collected from patients by a self completed questionnaire when attending dentists at a general dental practice and hospital clinics. Results: The estimated prevalence of dental anxiety in the totalsample was 17.0%. A higher proportion of females were highly anxious. Those attending the Dental Hospital were less likely to be anxious than those who were attending the Dental Practice. An inverse relationship between frequency of dental attendance and dental anxiety was found. Anxiety was significantly higher forthose respondents that indicated that a delay in their appointment would make them more anxious. Of the reported fears regarding their dental visit, 60% of respondents claimed that they were afraid it s going tohurt . When compared to non-anxious patients, more anxious patients feared feeling out of control , a negative experience , the needle, the drill, and being bothered by the smell associated with dental materials.The majority of respondents had a preference for a dentist that was young, friendly, talkative and native English speaking. In general, patients preferred the surgery temperature to be slightly cool. Regardless of anxiety level, 31.0% of patients said that they would prefer the chairside mouth rinse to be plain water with 49.1% not having a preference. Conclusions: This study demonstrates that a significant proportion of patients experience anxiety about visiting the dentist. Many of them have preferences about dentists and the surgery environment which may be modulators of their anxiety. Awareness by the dental profession of the causes of dental anxiety and measures taken by dentists tominimise these trigger factors could have a substantial impact on anxious patients.
Dental patient reported outcome and oral health-related quality of life measures: protocol for a systematic evidence map of reviews.
(Springer Nature, 2021-01-28) Beecher, Darragh; James, Patrice; Browne, John; Di Blasi, Zelda; Harding, Máiréad; Whelton, Helen
This research synthesis protocol addresses the question: what is the evidence concerning measurement properties of dental patient reported outcome measures (dPROMs), and regarding the real-world value of dPROMs, and where are the gaps in this evidence? Evidence mapping will systematically examine reviews of quantitative dPROMs used to assess the impact of oral health on the quality of life of dental patients and research participants. Evidence gaps where future research or systematic reviews are required will be identified. Materials and methods: This protocol accords with the PRISMA-P guideline. Open Science Framework Registration https://doi.org/10.17605/OSF.IO/RZD3N. Biomedical and grey literature databases will be searched, adapting the same search strategy. Published or unpublished reviews evaluating any dPROM will be considered for inclusion. There will be no restriction by date, setting, or language. AMSTAR2 and ROBIS will evaluate risk of bias. Psychometric criteria will be adapted from COSMIN. Data will be summarised separately for specific populations and conditions. Discussion The findings will enable clinicians and researchers to identify methodologically robust dPROMs, appropriate for use with relevant populations and conditions. Implications for real-world practice and research will be discussed.

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