Showing papers in "British Dental Journal in 1996"
184Â citations
TL;DR: Results show that gastro-oesophageal reflux is strongly associated with palatal erosion and that some patients presenting withPalatal dental erosion should be assessed for gastro-oeophageAl reflux as a possible cause, even in the absence of clinical symptoms of reflux.
Abstract: Thirty-six patients aged 15-74 with palatal dental erosion where the aetiology was unclear were investigated for gastro-oesophageal reflux. Ten subjects without symptoms of reflux or palatal erosion acted as controls. Distal and proximal oesophageal reflux were measured over 24 hours by dual channel antimony electrodes. Oral pH was measured simultaneously over the same period by a radio-telemetry capsule held palatally in a vacuum formed splint. Data were logged onto two portable digitable recorders. Twenty-three patients (64%) with palatal erosion had pathological gastro-oesophageal reflux compared with standard criteria. More than 4% of the total percentage time that the pH is less than 4 in the distal oesophagus is internationally recognised by gastroenterologists as representing a pathological level of reflux. The median percentage time < pH 4 in the distal oesophagus for these patients was 5.7%, in the proximal oesophagus, pH 4 was 0.5% and pH < 5 was 3.1%. In the mouth, the results for the percentage time that the pH < 5.5 was 0.3% and < 6 was 4.4%. A relationship was observed between the pH < 4 in the distal oesophagus and the mouth pH < 5.5 (r = 0.47, P = 0.002) and pH < 6 (r = 0.34, p = 0.02). There was a relationship between oral acid exposure time pH < 6 and the tooth wear index (r = 0.37, P = 0.01). These results show that gastro-oesophageal reflux is strongly associated with palatal erosion and that some patients presenting with palatal dental erosion should be assessed for gastro-oesophageal reflux as a possible cause, even in the absence of clinical symptoms of reflux.
178Â citations
TL;DR: The relatively simple clinical criteria of dentine consistency and dentine colour with the microbiological status of the tissue correlated significantly with the microbial findings.
Abstract: In the UK cavity preparation at the enamel-dentine junction (EDJ) is considered complete when all soft and/or stained tissue is removed. The aim of the present work was to link the clinical criteria of dentine consistency and dentine colour with the microbiological status of the tissue. Cavities were prepared in 564 teeth. Under rubber dam, access to the EDJ was gained and the sample sites selected (n = 847). Their consistency was noted as hard or soft and wet or dry when probed. The colour of the site was noted as stain-free or stained. Dentine was sampled using a round bur. After microbiological processing the total anaerobic count and counts of mutans streptococci and lactobacilli were expressed as log10 [CFU per sample]. Soft sites harboured significantly more bacteria than hard sites (P < 0.001). Soft and wet sites harboured significantly more bacteria than soft and dry sites (P < 0.001). Stained and hard sites harboured more bacteria than stain-free and hard sites (P < 0.05) but this difference was not considered to be clinically relevant. The relatively simple clinical criteria used here correlated significantly with the microbial findings. All soft dentine must be removed at the EDJ to ensure minimal infection of the underlying hard dentine. However, it may not be necessary to continue preparation until the EDJ is also stain-free.
119Â citations
TL;DR: It is demonstrated that application of Nd:YAG laser pulses of 50 mJ and 80 mJ failed to improve the clinical and microbiological parameters of periodontal disease.
Abstract: The aim of this study was to determine whether the Nd:YAG laser energies of 50 and 80 mJ at 10 pulses per second (pps) were capable of improving the clinical parameters associated with periodontal disease. These energy settings were chosen as previous work indicated that higher values would damage root surfaces and that 80 mJ had an in-vitro bactericidal effect. Eighty periodontally affected sites in teeth scheduled for extraction from 11 patients with adult periodontitis were randomly placed in one of the following four treatment groups: 1. laser treatment at 50 mJ, 10 pps for 3 minutes; 2. laser treatment at 80 mJ, 10 pps for 3 minutes; 3. scaling and 4. untreated control. Probing depth, bleeding on probing (BOP), plaque index, gingival index and gingival crevicular fluid (GCF) volume were measured at baseline and week 6. Baseline subgingival microbiological samples were collected, then repeated immediately after treatment and at week 6 to assess the total anaerobic colony forming units (CFU). Only the scaling group showed a significant reduction in pocket depth and BOP (P < 0.001). The microbial samples taken immediately after scaling and laser at 80 mJ and 10 pps treatments showed a significant reduction in total CFU compared with the baseline (P < 0.01), which was sustained only in the scaling group until week 6. Electron microscopy did not reveal any heat damage on the root surfaces. This study demonstrated that application of Nd:YAG laser pulses of 50 mJ and 80 mJ failed to improve the clinical and microbiological parameters of periodontal disease.
109Â citations
TL;DR: It is concluded that avoidance of lingual retraction reduces the incidence of temporary lingual nerve disturbance and does not increaseThe incidence of permanent damage, which indicates that use of the Howarth's in this way is invalid, and suggests that for the majority of cases, lingual Retraction should be avoided.
Abstract: The high incidence of lingual sensory disturbance following lower third molar removal in the UK may be due to the elevation of a lingual flap and insertion of a Howarth's periosteal elevator, in an attempt to protect the lingual nerve. We have therefore studied the validity of this technique by recording the incidence of temporary and permanent lingual nerve injury during 771 operations randomly allocated to be carried out with or without lingual flap retraction. Surgery with lingual flap retraction resulted in lingual sensory disturbance in 6.9% and this persisted, requiring lingual nerve repair, in 0.8%. Surgery without lingual flap retraction resulted in lingual sensory disturbance in 0.8% (P < 0.0001) and this persisted, requiring lingual nerve repair, in 0.3%. We conclude that avoidance of lingual retraction reduces the incidence of temporary lingual nerve disturbance and does not increase the incidence of permanent damage. This indicates that use of the Howarth's in this way is invalid, and suggests that for the majority of cases, lingual retraction should be avoided.
109Â citations
TL;DR: Major changes in the dental status of older adults have taken place in the last 30 years and these will continue, resulting in lower levels of edentulousness but a large need for maintenance of existing restorations.
Abstract: Major clinical findings from a dental survey of elderly people in three different English communities
81Â citations
TL;DR: There is no universally recognised impression disinfection/sterilisation protocol and it is recommended that all impressions should at least undergo a disinfecting procedure by immersion in 1% sodium hypochlorite for a minimum of 10 minutes.
Abstract: The potential for cross-infection from microbial contaminated dental impressions has long been recognised. This study set out to investigate impression decontamination procedures currently used in UK dental hospitals (1995) and to see how these may have changed since a previous survey, carried out in 1988. A variety of disinfection solutions and regimes were highlighted both within and between dental hospitals. Several of the disinfecting solutions currently being used have not been specifically tested for efficacy with impression materials. The laboratories were asked to highlight any adverse reactions. Five laboratories reported that some alginates resulted in casts with poor surface properties when immersed in hypochlorite (0.1 and 1%), sodium dichloroisocyanurate, and 2% glutaraldehyde solutions. This paper highlights that there is no universally recognised impression disinfection/sterilisation protocol. It is recommended that all impressions should at least undergo a disinfecting procedure by immersion in 1% sodium hypochlorite for a minimum of 10 minutes
71Â citations
TL;DR: Polyalkenoate cements probably should be regarded as 'fluoride depot' materials rather than fissure sealants when used in this context despite marked differences in retention.
Abstract: The 4-year results of a fissure sealant trial are reported. Glass polyalkenoate and bis GMA sealant were applied to 590 first permanent molar teeth using a half mouth study design in a group of 228 6-8-year-old children. Similar cariostasis was observed for the two materials at the end of 4 years despite marked differences in retention. Polyalkenoate cements probably should be regarded as 'fluoride depot' materials rather than fissure sealants when used in this context.
70Â citations
TL;DR: It is indicated that an understanding of disease processes and of available treatment options is an insufficient basis for treatment decision making, as many considerations outside these straightforward concepts of health are brought to bear on decisions made within the dental surgery.
Abstract: The day to day decisions made by general dental practitioners have a significant influence on the oral health of the population, and yet are often poorly understood. This paper describes a qualitative study which sought to identify issues, other than the extent of pathology, which impinge upon dentists' restorative treatment decision making. It also aimed to develop a classification of these issues. Content analysis of in-depth interviews with 20 randomly selected general dental practitioners delineated 10 broad areas of concern. While each of these topics may influence a treatment decision to a greater or lesser degree, the issues relating to treatment planning can be divided into a classification which involves patient, profession and practitioner characteristics. This study indicates that an understanding of disease processes and of available treatment options is an insufficient basis for treatment decision making, as many considerations outside these straightforward concepts of health are brought to bear on decisions made within the dental surgery.
69Â citations
TL;DR: It is recommended that all patients undergoing a surgical operation under endotracheal intubation should have a pre-operative dental check wherever possible and that the first dental examination would be conducted by an anaesthetist familiar with the predisposing factors.
Abstract: Although most anaesthetic textbooks cite dental injury as a complication of endotracheal intubation few studies have examined the extent and nature of the problem. Such damage however, formed the basis for one-third of all confirmed or potential anaesthetic claims notified to the Medical Protection Society between 1977 and 1986. This article seeks to explore the extent of the problem, outline predisposing factors, summarise current prophylactic measures and make recommendations to reduce the overall incidence. Increased awareness of the problem, by both anaesthetists and dental surgeons, coupled with appropriate prophylactic measures may result in a reduced incidence of dental injury arising from general anaesthesia. Given the high incidence of dental damage we recommend that all patients undergoing a surgical operation under endotracheal intubation should have a pre-operative dental check wherever possible. Clearly, the first dental examination would be conducted by an anaesthetist familiar with the predisposing factors. Where he/she considers there to be a higher than average risk of dental damage occurring during intubation a more specialised examination should be conducted by a dental surgeon. It may, where appropriate, be possible for remedial dental treatment to be carried out and customised mouth guards to be constructed prior to the operation. Obviously such recommendations have certain financial implications and would have to be subject to controlled cost-benefit analysis before their widespread application.
67Â citations
TL;DR: A dental health survey was included as part of a large scale study of nutrition in preschool children and found that dental decay was most strongly related to social background and social class.
Abstract: The national diet and nutrition survey of 1.5 to 4.5 year old children: summary of the findings of the dental survey
TL;DR: The results suggest that many patients with dental pain may seek treatment from medical practitioners, prior to, or in place of, definitive dental treatment, and rationalisation of antibiotic prescription and the provision of emergency dental treatment is needed.
Abstract: To determine the pattern of antibiotic prescribing (source and type) for acute dental conditions in the emergency setting, a prospective cross-sectional study was undertaken of 500 consecutive new patients attending the examination and emergency clinic of the Cardiff Dental Hospital in May 1994. The source and type of antibiotics prescribed, the nature of complaint and type of antibiotic prescribed in the primary care and dental hospital setting were recorded. Antibiotic prescription was a feature of the treatment of 30% (149/500) of patients. The 60 patients who had received emergency treatment prior to attending the hospital emergency clinic had been prescribed a total of 14 different types of antibiotics; 41% of these patients had sought treatment from general medical practitioners. Antibiotics were frequently prescribed without generally accepted criteria and there was wide variation in prescribing. Overall, only seven different types of antibiotics were prescribed in the dental hospital setting. The use of second generation antibiotics was more common in general practice than in the dental hospital. The results suggest that many patients with dental pain may seek treatment from medical practitioners, prior to, or in place of, definitive dental treatment. In summary, rationalisation of antibiotic prescription and the provision of emergency dental treatment is needed.
TL;DR: Six types of transposition are described, discussing the problems and possible solutions and it is important to ensure that the results of any treatments for transpositions are both aesthetic and functional.
Abstract: Tooth transposition is an uncommon dental anomaly that nevertheless has important implications regarding treatment. This article describes six types of transposition, discussing the problems and possible solutions. It is important to ensure that the results of any treatments for transposition are both aesthetic and functional.
TL;DR: The relationship between dental attendance and oral disease, the consequences of irregular attendance, and what advice on oral health practitioners should be giving their patients for the 21st century are considered.
Abstract: A recent general public survey on dental health identified "the missing 50 per cent'. In the light of this, Professor Murray considers the relationship between dental attendance and oral disease, the consequences of irregular attendance, and what advice on oral health practitioners should be giving their patients for the 21st century.
TL;DR: The prevalence, common presentation, differential diagnosis, likely aetiology, prevention and management of suspected cases of erosion-related tooth wear are considered.
Abstract: This article aims to address the issues arising out of the increasing concern by general dental practitioners of erosion-related tooth wear. The prevalence, common presentation, differential diagnosis, likely aetiology, prevention and management of suspected cases of this form of tooth wear are considered.
TL;DR: EMLA is useful in reducing the pain of palatal injections and electronic nerve stimulation did not differ significantly from placebo.
Abstract: This paper describes a model for investigating the efficacy of different methods of alleviating the pain of intra-oral injections. The efficacies of the topical anaesthetic EMLA cream and electronic nerve stimulation as means of reducing the discomfort of palatal injections prior to the extraction of maxillary teeth were investigated using the model in one hundred patients. EMLA reduced the pain of injection compared with placebo (P < 0.05) whereas the pain reported after electronic nerve stimulation did not differ significantly from placebo. It is concluded that EMLA is useful in reducing the pain of palatal injections
TL;DR: The authors can claim that further clinical studies are necessary to identify exactly what factors influence the success of cantilever and other resin-bonded designs, as it is necessary to predict predictable long-term success.
Abstract: Resin-bonded restorations have many advantages over conventional alternatives. Advances in adhesive technology together with a better understanding of the clinical function of such restorations have allowed resin-bonded bridges to play an important role in everyday clinical practice. This paper highlights the role and importance of the single abutment, single pontic cantilever resin-bonded bridge. Clinical experience might suggest that the cantilever design offers a viable alternative to other designs. Furthermore, the paper suggests that when cantilever resin-bonded bridges fail initially, re-bond often leads to predictable long-term success. Factors such as patient selection, abutment preparation, retainer design and the aesthetic limitations of resin-bonded bridges are also discussed. The authors can claim that further clinical studies are necessary to identify exactly what factors influence the success of cantilever and other resin-bonded designs.
TL;DR: There was a marked variation in referral rates between the dentists and many patients were referred unnecessarily and referral guidelines for orthodontic treatment are necessary and they should be directed at all general dental practitioners.
Abstract: One concern to both providers and consumers of orthodontic treatment is the length of new patient consultation waiting lists. A possible reason for the excessive length of these lists could be unnecessary referral of patients. This research project aimed to identify whether inappropriate referrals for new patient orthodontic consultations were a significant problem. The study was carried out in two FHSA areas in the north of England in two stages. The first part of the study involved an evaluation of GDP referral patterns to orthodontic secondary care providers. In the second part, information on the patients referred by the dentists was collected. We concluded that there was a marked variation in referral rates between the dentists and many patients were referred unnecessarily. Importantly, there was no association between dentists' referral rate and the number of inappropriate referrals made. It appears that referral guidelines for orthodontic treatment are necessary and they should be directed at all general dental practitioners.
TL;DR: Results indicate that advice against smoking combined with dental health instruction and periodontal care can be an effective aid to reducing tobacco consumption.
Abstract: Ninety-eight cigarette smokers attending the Newcastle upon Tyne Dental Hospital, wishing to reduce their tobacco consumption, received smoking reduction advice in combination with dental health instruction and periodontal care. Those advised against smoking showed a greater reduction (P < 0.001) in reported cigarette consumption during treatment and follow-up, compared with 38 control subjects who received dental health instruction but no advice against smoking. Fifty percent of intervention subjects reported reducing to half or less than half of their initial cigarette consumption, compared with 24% for controls. Eighty percent of those advised against smoking reported some reduction, against 29% for controls. The reported smoking cessation rate in the intervention group was 13.3%, compared with 5.3% in the control subjects. The results indicate that advice against smoking combined with dental health instruction and periodontal care can be an effective aid to reducing tobacco consumption.
TL;DR: Oral use of cocaine in two patients resulted in unusual white lesions on their anterior maxillary gingivae/vestibule, and GDPs should be alert to this newly described lesion.
Abstract: Cocaine abuse is a major public health problem worldwide and is increasingly common in Europe. Oral use of cocaine in two patients resulted in unusual white lesions on their anterior maxillary gingivae/vestibule. GDPs should be alert to this newly described lesion.
TL;DR: The aim should be to reduce the use of general anaesthesia in hospitals, not to increase its use, Shaw and Weatherill argue.
Abstract: Recent surveys of children have shown the use of general anaesthesia for extractions by GDPs has declined while its use in hospitals may actually have increased. Shaw and Weatherill argue the aim should be to reduce its use.
TL;DR: The appropriateness of surgical removal of lower third molars was audited in relation to 500 consecutive patients referred to hospital for third molar management during 1993/4 and findings suggest that criteria for removal other than NIH criteria are being applied.
Abstract: An investigation of the rationality of lower third molar removal, based on USA National Institutes of Health criteria
TL;DR: Lingual nerve damage during lower third molar removal: a comparison of two surgical methods suggests that the former is more effective than the latter.
Abstract: Lingual nerve damage during lower third molar removal: a comparison of two surgical methods
TL;DR: Two cases are presented where patients referred for assessment of third molar problems subsequently revealed on radiological examination the asymptomatic phenomenon of transmigration.
Abstract: Transmigration is a rare occurrence relating to the movement of a mandibular canine across the mid-line of the mandible. Two cases are presented where patients referred for assessment of third molar problems subsequently revealed on radiological examination the asymptomatic phenomenon of transmigration. With dental panoramic radiography becoming more widespread among dental practitioners it is possible that more cases of transmigration will be observed.
TL;DR: Gender differences were pronounced in the north, with men being less concerned about edentulousness, more likely to opt for restoration and less likely to visit the dentist than women and in the south this difference was less evident.
Abstract: Dental attitudes and behaviour among a sample of dentate older adults from three English communities
TL;DR: Recent developments in the design of visible light activation units are reviewed and the desirable features such units should possess are outlined.
Abstract: New light-cured dental materials are constantly being developed and marketed in response to the increasing demand for aesthetic dentistry. Therefore light activation units are now a standard item of equipment in everyday dental practice. Many factors are involved in the selection of a light unit and among these is the need for the unit to polymerise light-activated resin restorations effectively. This article reviews recent developments in the design of visible light activation units and outlines the desirable features such units should possess. In addition, factors influencing the effectiveness of light-activation units are discussed and recommendations made regarding their routine testing, use and maintenance.
TL;DR: Comparison with results of the last study provides little evidence of improvement in dental health in young children in this low fluoride area, with a small proportion suffering relatively severely from caries.
Abstract: Previous surveys carried out in the inner city area of Camden between 1966 and 1986 gave indication of a deterioration in dental health in pre-school children during the 1980s. Four hundred and six children were included in the current survey, which used the same sampling and methodology as previously. The aims of the present survey were to determine the current prevalence of caries and of rampant caries and to relate prevalence to social factors, to infant feeding habits and to the use of sweetened comforters, and to determine the extent of dental care received. Caries affected 11% of 2-year-old children and 29% of 3-year-olds, rampant caries affected 6% and 14% respectively, A higher likelihood of caries occurred in children of Asian origin and those given a sweetened comforter. For rampant caries, likelihood was greater amongst those of Asian origin and those given a sweet drink in a bottle for 2 years or longer. Comparison with results of the last study provides little evidence of improvement in dental health in young children in this low fluoride area, with a small proportion suffering relatively severely from caries.
TL;DR: Comparing the stress experienced by dentists working under two different systems of remuneration suggests that, for dentists at least, changing from NHS to an independent capitation scheme is of great benefit.
Abstract: A qualitative research methodology was used to compare the stress experienced by dentists working under two different systems of remuneration. No absolute difference was found in the levels of stress experienced by the two groups, as measured by a questionnaire measure of stress experience. Both groups of dentists identified patient management, time pressures and staff and practice management as sources of stress, though the independent capitation scheme dentists felt that they were under less time pressure and faced considerably less paperwork. Techniques for stress management identified by the dentists were limited and symptom-focused. The results suggest that, for dentists at least, changing from NHS to an independent capitation scheme is of great benefit
TL;DR: A questionnaire was devised involving a group of dental students and a group comprising all consultant orthodontists in the UK to investigate the prevalence and role of handedness in dental specialisation and no significant correlation was noted between handedness and any other variable between the two dental groups.
Abstract: A questionnaire was devised involving a group of dental students (n = 70) and a group comprising all consultant orthodontists in the UK (n = 170) to investigate the prevalence and role of handedness in dental specialisation. Subjects were classified as being pure left-, mixed- or pure right-handed according to responses to a hand preference questionnaire and the results were compared with a very similar previous study of the general population. The prevalence of sinistrality (self-classified by writing) was recorded as 8.6% among dental students and 17.2% amongst orthodontists; this compares with 7.4% among the general population. More mixed-handers presented in both the dental groups compared to the general population. This agreed with the right shift theory of laterality. No significant correlation was noted between handedness and any other variable between the two dental groups.