Cork University Dental School and Hospital - Journal Articles
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Item No more amalgams: Use of amalgam and amalgam alternative materials in primary dental care(Springer Nature, 2018-07-27) Lynch, Christopher D.; Farnell, D. J. J.; Stanton, H.; Chestnutt, I. G.; Brunton, P. A.; Wilson, N. H. F.; PRIME Centre WalesObjectives: The aim of this study was to investigate the use of dental amalgam and amalgam alternate materials in primary dental care in Wales. Methods: Following pre-piloting, a questionnaire was distributed to 667 dentists registered as working in primary dental care in Wales. The questionnaire sought to determine the current use of amalgam, and amalgam alternative materials in primary dental care services in Wales. In addition, the questionnaire sought to determine the attitudes and confidence of dentists in respect of placement of resin composites as alternatives to dental amalgam. Results: A response rate of 40.4% was achieved (n = 270). High levels of reported confidence were seen in relation to placing resin composites in posterior teeth, but these levels reduced as the complexity of the cavity increased (while 82% of respondents 'strongly agreed' that they felt confident in placing resin composites in occlusal cavities, this reduced to 52.6% for three-surface occlusoproximal cavities). Patterns of care suggested that 73.3% of respondents often, or always, place amalgam restorations for NHS-funded dentistry in adults, where two or more posterior restorations are required. This proportion drops to 27% for the same scenario in children, and 19.4% in privately-funded care for adults. Sixty-seven percent of respondents reported that restoring posterior teeth with resin composite is too expensive for NHS-funded dentistry. A similar proportion of respondents (65.9%) agreed, or strongly agreed, that having to place resin composite routinely in posterior teeth would cause appointment delays. Respondents estimated that it would take them 1.61 times as long on average to place a resin composite, compared to an amalgam, in a moderately deep two-surface proximal-occlusal cavity in a lower first permanent molar. Respondents felt that the NHS fees would have to increase by 55–60% to support the restoration of posterior teeth with resin composite, rather than dental amalgam. Conclusions: This study provided insight into current practising arrangements of primary dental care practitioners in relation to the use of dental amalgam and resin composites in the restoration of posterior teeth. Based on a sample of mainly UK-trained dentists, it would seem that amalgam remains the material typically selected for restoring posterior teeth in adults for NHS-funded care. While dentists are knowledgeable and embracing of new techniques for posterior resin composite placement, funding arrangements in NHS dentistry appear to be a barrier to the increasing use of resin composite-based, minimum intervention approaches to the restoration of posterior teeth.Item Contemporary teaching of bridges (fixed partial dentures) in Ireland and United Kingdom dental schools(Springer Nature, 2018-05-11) Virdee, S. S.; Lynch, Christopher D.; Sadaghiani, L.; Addy, L. D.; Gilmour, A. S. M.; Blum, I. R.; Wilson, N. H. F.Aim: The aim of this study was to investigate and describe the current teaching of bridges (fixed partial dentures) within dental schools in Ireland and the United Kingdom. The authors previously surveyed this teaching in 2009. Method: Following receipt of positive ethical approval, an online survey was distributed to the 18 dental schools in Ireland and the United Kingdom with primary dental degree programmes in 2017. This questionnaire sought information about the current nature and extent of dental school teaching of bridges, including clinical techniques taught. Information was also sought on current and future challenges to teaching in this area. Results: Responses were received from all 18 schools invited to participate (response rate = 100%). There was diversity in the range of exercises completed in preclinical courses for bridgework: the greatest commonality was seen in relation to preparation exercises for fixed-fixed posterior conventional bridges (n = 14 schools) and cantilever anterior resin-retained bridges (n = 13 schools). Fourteen schools required students to complete a preclinical assessment before they were permitted to provide bridgework in a clinical setting. Anterior cantilevered resin retained bridges were the most common clinical treatment provided (average = 1.67 bridges per student per respondent school; range = 0–3), representing a two-fold increase since the 2009 survey, which indicated that the equivalent mean was 0.83 per student. Two schools permitted their students to provide all-ceramic anterior bridges clinically. Five schools reported that their teaching of bridges had reduced over the past 5 years. Within the respondent schools, the most common challenges cited to teaching bridges was a lack of suitable patients (13 schools) and lack of time within the primary dental degree programme (7 schools). Conclusions: This study found increased student experience in the clinical provision of bridgework, in particular the provision of anterior cantilever resin-retained bridges, compared to the time of the last survey in 2009. Aspects of the teaching of removable partial dentures and implant dentistry should be surveyed to identify how these areas of teaching are adapting to changing patterns of oral healthcare and the further refinement of developing technologies in these areas.Item Extraction of premolars for orthodontic reasons on the decline? A cross-sectional survey of BOS members(Taylor and Francis, 2018-09-07) Fleming, Padhraig S.; Cunningham, Susan J.; Benson, Philip E.; Jauhar, Preeti; Millett, DeclanObjective: To obtain the opinion of British Orthodontic Society (BOS) members in relation to possible patterns of prescription of orthodontic extractions over the past 5–10 years and to relate any changes identified to treatment objectives, facial and smile aesthetics, and treatment strategies and adjuncts. Design: Cross-sectional questionnaire. Setting: On-line survey of BOS members. Methods: A 14-item on-line questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered demographics, possible changes in frequency of prescribed extractions with specific information concerning the effect of patient age, and the influence of other factors including alternative approaches to space creation, evolving treatment mechanics, smile and facial aesthetics, and retention protocols. Results: Two hundred and eight responses were obtained with 95.6% (n = 199) reporting reduced extraction prescription over the last 5–10 years. Overall, 29.9% and 35.5% felt that their threshold for extractions had increased by more than 2 mm in adolescents and adults, respectively. Facial (n = 145; 69.7%) and smile (n = 127; 61.1%) aesthetics, and increased use of inter-proximal reduction (n = 102; 49%) were the factors most frequently reported as having either a moderate or major influence on this trend. Based on ordinal logistical regression analyses, no significant relationship was found between threshold for extractions and work setting (P = 0.675; O.R. 0.51; 95% CI: 0.39, 1.85) or level of orthodontic experience (P = 0.15; O.R. 1.02; 95% CI: 0.15, 1.05), although a higher threshold for extractions was more likely among users of conventional than self-ligating brackets (P = 0.001; O.R. 4.74; 95% CI: 1.95, 11.5). Conclusions: A reduced tendency to prescribe orthodontic extractions over the past 5–10 years among British Orthodontic Society members was identified. Comparative clinical research exploring the relative merits of extraction and non-extraction approaches could be timely.Item Investigating the impact of self‐management behaviours on quality of life and fear of recurrence in head and neck cancer survivors: A population‐based survey(John Wiley & Sons, Inc., 2019-01-29) Dunne, Simon; Coffey, Laura; Sharp, Linda; Desmond, Deirdre; Cullen, Claire; O'Connor, Jean; O'Sullivan, Eleanor; Timon, Conrad; Gallagher, Pamela; Irish Cancer Society; Health Research BoardObjectives: Emerging cancer‐survivorship research suggests that self‐management can lead to improved outcomes. However, research examining the impact of self‐management behaviours on quality of life (QoL) and fear of recurrence (FoR) in cancer survivors is lacking. This study investigated the relationship between self‐management behaviours and QoL and FoR following treatment for head and neck cancer (HNC). Methods: Postal surveys were sent to 734 eligible HNC survivors (ICD10 C01‐C14; C32) in the Republic of Ireland who were 12‐ to 60‐months post diagnosis. QoL and FoR were measured using the Functional Assessment of Cancer Therapy (FACT‐G and Head and Neck Cancer Subscale) measure and Fear of Relapse/Recurrence Scale, respectively. Seven self‐management behaviours were measured using the Health Education Impact Questionnaire. Results: Three hundred and ninety‐five HNC survivors completed surveys (50.3% response rate). After controlling for sociodemographic and clinical characteristics, self‐management behaviours accounted for 20% to 39.4% of the variance in QoL and FoR. Higher scores on positive and active engagement in life, constructive attitudes and approaches, and skill and technique acquisition were significantly associated with higher global QoL and lower FoR, whilst higher scores on positive and active engagement in life and constructive attitudes and approaches only were significantly associated with higher HNC‐specific QoL. Additionally, lower scores on self‐monitoring and insight were significantly associated with higher HNC‐specific and global QoL and lower FoR. Conclusions: The findings highlight the potential utility of self‐management interventions promoting active problem solving, positive self‐talk, and skill acquisition amongst cancer survivors. However, increased self‐monitoring may relate to negative outcomes in HNC, a finding that warrants further investigation.Item A randomised controlled study on the effects of different surface treatments and adhesive self-etch functional monomers on the immediate repair bond strength and integrity of the repaired resin composite interface(Elsevier Ltd, 2019) Martos, Renata; Hegedüs, Viktória; Szalóki, Melinda; Blum, Igor R.; Lynch, Christopher D.; Hegedüs, Csaba; European Regional Development Fund; Hungarian GovernmentObjectives: To evaluate the effects of different surface conditioning methods on the immediate repair bond strength and integrity of the repaired composite interface. Methods: One hundred and five resin composite blocks made of a nanohybrid resin composite were randomly assigned to one of the following surface conditioning groups (n = 15/group): Group 1: Gluma Self Etch™ adhesive system, Group 2: Tokuyama Bond Force II™ adhesive system, Group 3: non-roughened and non-conditioned surfaces, Group 4: sandblasting and Gluma Self Etch™, Group 5: sandblasting and Tokuyama Bond Force II™, Group 6: sandblasting only. A positive control group was also used. Resin composite identical to the substrate was applied and the repaired specimens were subjected to shear bond strength (SBS) testing. Representative samples from all groups were subjected to scanning electron microscopy and surface profilometry to determine their mode of failure. The data were analysed statistically using Analysis of Variance (ANOVA) and two independent sample t-test (α = 0.05). Results: The mean SBS of all test groups ranged between 1.92 and 5.40 MPa and varied with the degree of composite surface roughness and the type of adhesive system employed. Significantly highest SBS values (5.40 ± 0.36 MPa) were obtained in Group 5 (p = 0.017) which were comparable to the coherent strength of the resin composite in the positive control group (p > 0.05). Conclusions: Under the tested conditions, significantly greater SBS of repaired resin composite was achieved when the substrate surface was conditioned by sandblasting followed by the application of the Tokuyama Bond Force II™ adhesive system. Clinical significance: Effecting a repair of a nanohybrid composite restoration with sandblasting and the application of TBF II would seem to enhance the interfacial bond strength and integrity of the repaired resin composite interface. Clinical trials are necessary to determine the usefulness of this technique. © 2019 Elsevier Ltd