Showing papers in "British Dental Journal in 2014"
TL;DR: Different means of delivery are used for root canal irrigation, from traditional syringe-needle delivery to various machine-driven systems, including automatic pumps and sonic or ultrasonic energy.
Abstract: Irrigation is a key part of successful root canal treatment. It has several important functions, which may vary according to the irrigant used: it reduces friction between the instrument and dentine, improves the cutting effectiveness of the files, dissolves tissue, cools the file and tooth, and furthermore, it has a washing effect and an antimicrobial/antibiofilm effect. Irrigation is also the only way to impact those areas of the root canal wall not touched by mechanical instrumentation. Sodium hypochlorite is the main irrigating solution used to dissolve organic matter and kill microbes effectively. High concentration sodium hypochlorite (NaOCl) has a better effect than 1 and 2% solutions. Ethylenediaminetetraacetic acid (EDTA) is needed as a final rinse to remove the smear layer. Sterile water or saline may be used between these two main irrigants, however, they must not be the only solutions used. The apical root canal imposes a special challenge to irrigation as the balance between safety and effectiveness is particularly important in this area. Different means of delivery are used for root canal irrigation, from traditional syringe-needle delivery to various machine-driven systems, including automatic pumps and sonic or ultrasonic energy.
395 citations
TL;DR: An emerging role for dental professionals is envisaged, in which diabetes screening tools could be used to identify patients at high risk of diabetes, to enable them to seek further investigation and assessment from medical healthcare providers.
Abstract: Periodontitis and diabetes are common, complex, chronic diseases with an established bidirectional relationship. That is, diabetes (particularly if glycaemic control is poor) is associated with an increased prevalence and severity of periodontitis, and, severe periodontitis is associated with compromised glycaemic control. Periodontal treatment (conventional non-surgical periodontal therapy) has been associated with improvements in glycaemic control in diabetic patients, with reductions in HbA1c of approximately 0.4% following periodontal therapy. For these reasons, management of periodontitis in people with diabetes is particularly important. The dental team therefore has an important role to play in the management of people with diabetes. An emerging role for dental professionals is envisaged, in which diabetes screening tools could be used to identify patients at high risk of diabetes, to enable them to seek further investigation and assessment from medical healthcare providers.
219 citations
TL;DR: The aetiological factors of post-treatment apical periodontitis are focused on and the indications and basics of the procedures for optimal clinical management of this condition are discussed.
Abstract: Endodontic treatment failure is usually characterised by the presence of post-treatment apical periodontitis, which may be persistent, emergent or recurrent. The major aetiology of post-treatment disease is persistent intraradicular infection, but in some cases a secondary intraradicular infection due to coronal leakage or an extraradicular infection may be the cause of failure. Understanding the causes of endodontic treatment failure is of paramount importance for the proper management of this condition. Teeth with post-treatment apical periodontitis can be managed by either nonsurgical endodontic retreatment or periradicular surgery, both of which have very high chances of restoring the health of the periradicular tissues and maintaining the tooth function in the oral cavity. This review article focuses on the aetiological factors of post-treatment apical periodontitis and discusses the indications and basics of the procedures for optimal clinical management of this condition.
177 citations
TL;DR: The restoration of endodontically treated teeth has undergone significant changes in the last 20 years, most of these changes are associated with the preservation of tooth structure, this has been achieved first of all with the increasing use of operative microscopes, nickel titanium instruments and more recently cone beam computed tomography.
Abstract: The restoration of endodontically treated teeth has undergone significant changes in the last 20 years. Most of these changes are associated with the preservation of tooth structure, this has been achieved first of all with the increasing use of operative microscopes, nickel titanium instruments and more recently cone beam computed tomography; these instruments have allowed the clinicians to reduce significantly the amount of coronal and radicular hard tooth tissue removed in the process of cutting access cavities. The use of composites has also allowed the clinicians to restore with adhesive techniques teeth that would otherwise require extensive and destructive mechanical retentions. The use of partial crowns is becoming increasingly popular and this also helps prevent tooth structure loss. This article will focus on the choices available to restore both anterior and posterior teeth and will focus more on these contemporary adhesive techniques.
119 citations
TL;DR: Current clinical and laboratory data are addressed to provide an overview of this new endodontic paradigm and to minimise structural changes during root canal therapy, which may result in a new strategy that can be labelled 'minimally invasive endodentics'.
Abstract: The primary goal of endodontic therapy is the long-term retention of a functional tooth by preventing or treating apical periodontitis. However, there are many other factors that impact endodontic outcomes such as the quality of the restoration and structural integrity of the tooth after root canal preparation. Contemporary research efforts are currently directed to better understanding dentin behaviour and structure during aging and function. An alternative approach is to minimise structural changes during root canal therapy, which may result in a new strategy that can be labelled 'minimally invasive endodontics'. This review addresses current clinical and laboratory data to provide an overview of this new endodontic paradigm.
101 citations
TL;DR: Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands that consist of an amorphous mineralised nucleus, surrounded by concentric laminated layers of organic and inorganic substances.
Abstract: Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. Sialoliths are more frequently located in the submandibular gland (84%), than in the parotid gland (13%). The majority of the submandibular stones are located in Wharton's duct (90%), whereas parotid stones are more often located in the gland itself. Salivary stones consist of an amorphous mineralised nucleus, surrounded by concentric laminated layers of organic and inorganic substances. The organic components of salivary stones include collagen, glycoproteins, amino acids and carbohydrates. The major inorganic components are hydroxyapatite, carbonate apatite, whitlockite and brushite. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland.
86 citations
TL;DR: This information will help the reader to understand not only the way that plaque may have an impact on oral tissues but also why regular effective cleaning may improve periodontal health.
Abstract: An appreciation of dental plaque and the host response provides an essential basis from which to understand the disease process and treatment rationale. This information will help the reader to understand not only the way that plaque may have an impact on oral tissues but also why regular effective cleaning may improve periodontal health and why some individuals appear to have a greater susceptibility to periodontitis than others, either intrinsically or in relation to various systemic factors.
82 citations
TL;DR: There was a wide diversity between recommendations on toothbrushing techniques, how often people should brush their teeth and for how long and the unacceptably large diversity in recommendations on what toothbrushes method to use should concern the dental profession.
Abstract: Objectives To assess the methods of toothbrushing recommended for both adults and children by dental associations, toothpaste and toothbrush companies and professional sources such as in dental textbooks and by experts. Secondly, to compare the advice by source and whether recommendations differed for adults and for children. Methods Examination of online material on methods of toothbrushing from dental associations, toothpaste and toothbrush companies and associated organisations providing professional advice; as well as from dental texts. Results There was a wide diversity between recommendations on toothbrushing techniques, how often people should brush their teeth and for how long. The most common method recommended was the Modified Bass technique, by 19. Eleven recommended the Bass technique, ten recommended the Fones technique and five recommended the Scrub technique. The methods recommended by companies, mainly toothpaste companies, differed from those of dental associations, as did advice in dental textbooks and research-based sources. There was a wide difference in the toothbrushing methods recommended for adults and for children. Conclusions The unacceptably large diversity in recommendations on what toothbrushing method to use should concern the dental profession. Higher grades of evidence of effectiveness of toothbrushing techniques are required to inform professional bodies that develop guidelines on toothbrushing.
77 citations
TL;DR: This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanent molars in children.
Abstract: This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanent molars in children. The first permanent molar is susceptible to chronological enamel defects, molar-incisor hypomineralisation and caries, which may necessitate enforced extraction in the developing dentition. In the right circumstances, the extraction of these teeth can be followed by successful eruption of the second permanent molar and ultimately, third molar eruption to complete the molar dentition. For this reason, elective extraction of first permanent molars with a questionable long-term prognosis should be considered when planning enforced extractions. However, a number of factors can influence the decision-making process, including the necessity for a general anaesthetic to allow extraction, potential cooperation with restorative or orthodontic treatment and likely future preventative practice within the family. Moreover, the presence of any underlying malocclusion also needs to be evaluated within the context of extraction planning. The current available evidence has been evaluated and awarded a grade based upon those recommended by the Scottish Intercollegiate Guidelines Network.
75 citations
TL;DR: There was a high prevalence of apical periodontitis and poor technical quality root canal treatment; a strong association between AP and root filled teeth, and between the periapical health and the technical quality of the root Canal treatment.
Abstract: Apical periodontitis and the technical quality of root canal treatment in an adult sub-population in London
63 citations
TL;DR: The principles of non-invasive management ofnon-cavitated (initial) occlusal caries lesions are described, based on evidence from recent studies published in the international literature.
Abstract: Epidemiological data on dental caries show that prevention and treatment needs have evolved significantly over the past two decades. In younger patients the distribution of caries lesions is mainly found on the occlusal surfaces. The treatment approaches utilised by dentists must evolve to integrate preventive and treatment solutions tailored to the care needs, which are straightforward to implement in the dental office and whose effectiveness is underpinned by scientific evidence. This article aims to describe the principles of non-invasive management of non-cavitated (initial) occlusal caries lesions, based on evidence from recent studies published in the international literature.
TL;DR: Current periodontal care modalities have a remarkably weak evidence base, with considerable resources allocated to fund interventions that include oral hygiene instruction, scale and polishes through to surgical interventions.
Abstract: Clinically defined periodontal disease is highly prevalent, has considerable impacts on individuals and society and is costly to treat; the cost of dental care is the fourth highest costs of all diseases and consuming between 5 and 10% of all healthcare resources. Changes in the epidemiology of clinically defined periodontal diseases suggest that the prevalence of severe periodontal disease is low and rates of progression of periodontal destruction tend to be relatively slow. Current periodontal care modalities have a remarkably weak evidence base, with considerable resources allocated to fund interventions that include oral hygiene instruction, scale and polishes through to surgical interventions. The public health problem lies more in the failure in design of a contract between dental professionals and the state. Such a contract needs to recognise both the wider determinants of disease and the role that dental professionals could play: a contract that concentrated on rewarding outcomes, namely a diminution in treatment need, as opposed to one based simply on the number of interventions would be a major step forward.
TL;DR: There is high quality evidence that ibuprofen is superior to paracetamol and the novel combination drug shows encouraging results when compared to the single drugs (based on two trials).
Abstract: This paper compares the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth. In this systematic review only randomised controlled double-blinded clinical trials were included. We calculated the proportion of patients with at least 50% pain relief at 2 and 6 hours post dosing, along with the proportion of participants using rescue medication at 6 and 8 hours. Adverse events were also analysed. Data was meta-analysed where possible. Seven studies were included with a total of 2,241 participants enrolled. Ibuprofen 400 mg is superior to 1,000 mg paracetamol with a risk ratio for at least 50% pain relief at 6 hours of 1.47 (95% confidence interval [CI] 1.28 to 1.69). For the combined drug, the risk ratio for at least 50% maximum pain relief over 6 hours is 1.77 (95% CI 1.32 to 2.39) based on total pain relief (TOTPAR) data. There is high quality evidence that ibuprofen is superior to paracetamol. The novel combination drug shows encouraging results when compared to the single drugs (based on two trials).
TL;DR: The available evidence on implant survival/success, as well as relevant surgical recommendations in patients affected by systemic diseases, are evaluated and when possible, practical suggestions for the clinician are provided.
Abstract: Several systemic diseases (and relative medications) have been reported to impair or in some cases complicate dental implant surgery. In broader terms, when dealing with patients suffering from systemic diseases, the monitoring of the medical condition and of the related post-operative complications is of great importance in order to avoid risks which could jeopardise the health of the patient. In this review, the available evidence on implant survival/success, as well as relevant surgical recommendations in patients affected by systemic diseases, are evaluated and when possible, practical suggestions for the clinician are provided.
TL;DR: The number of people being diagnosed with mouth cancer (oral cancer) is increasing, with notable rises in incidence in younger people and in females, and infection with human papillomavirus increases the risk of some types of mouth cancer.
Abstract: The number of people being diagnosed with mouth cancer (oral cancer) is increasing, with notable rises in incidence in younger people and in females. There are certain lifestyle habits that can increase the risk of mouth cancer, such as smoking or chewing tobacco, drinking alcohol above recommended levels (especially in those who also smoke), and chewing betel nut (areca nut). Infection with human papillomavirus (HPV) increases the risk of some types of mouth cancer, and too much sun exposure may also raise the risk of lip cancers. The signs and symptoms of mouth cancer can often be seen or felt, and any red or white patch, ulcer or lump can be an early sign if it lasts for three or more weeks. If people notice any of these changes, they should seek help from their dentist, doctor, or another healthcare professional without delay, because if mouth cancer is diagnosed at an early stage, when the lesions are small, treatment is generally less complicated and more effective.
TL;DR: The experience in developing, introducing and refining a surgical safety checklist for outpatient oral surgery along with the key strategic actions needed to ensure effective cultural change and optimum patient safety in the outpatient setting are described.
Abstract: Extraction of the wrong tooth or teeth is a serious and avoidable clinical error causing harm to the patient. All NHS Trusts in England are required to use a surgical safety checklist in operating theatres to prevent incorrect site surgery and ensure safe management of patients. However, the majority of patients have dental extractions and other oral surgical procedures undertaken on an outpatient basis and these patients are also at risk of having an incorrect site surgical procedure such as a wrong tooth extraction. We describe our experience in developing, introducing and refining a surgical safety checklist for outpatient oral surgery along with the key strategic actions needed to ensure effective cultural change and optimum patient safety in the outpatient setting.
TL;DR: A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective), which allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint.
Abstract: Background There is no universally accepted, precise definition, nor standardisation in terminology and classification of halitosis. Objective To propose a new definition, free from subjective descriptions (faecal, fish odour, etc), one-time sulphide detector readings and organoleptic estimation of odour levels, and excludes temporary exogenous odours (for example, from dietary sources). Some terms previously used in the literature are revised. Results A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective). In reality, any halitosis complaint is potentially the sum of these types in any combination, superimposed on the Type 0 (physiologic odour) present in health. Conclusion This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.
TL;DR: The anti-inflammatory steroids, non-steroidal drugs and anti-TNF-α agents might all be expected to exert a dampening effect on chronic periodontitis although the evidence is somewhat equivocal and none of these drugs has emerged as potentially valuable adjuncts to treat periodontal disease.
Abstract: This paper reviews the effects that drugs may have on the gingival and periodontal tissues. Drug-induced gingival overgrowth has been recognised for over 70 years but is becoming a more prevalent occurrence with wider use of antihypertensive and immunosuppressant drugs. The anti-inflammatory steroids, non-steroidal drugs and anti-TNF-α agents might all be expected to exert a dampening effect on chronic periodontitis although the evidence is somewhat equivocal and none of these drugs has emerged as potentially valuable adjuncts to treat periodontal disease. Desquamative gingivitis is a clinical appearance of aggressive gingival inflammation with which a number of drugs have been associated and the oral contraceptives have also been implicated in the development of gingival inflammation. Patients who are prescribed bisphosphonates and anti-platelet drugs are at risk of serious side effects following more invasive dental procedures including extractions and surgical treatments although timely, conventional management of periodontal disease may be undertaken to reduce periodontal inflammation, prevent disease progression and ultimately the need for extractions.
TL;DR: An overview of the rationale behind taking a contemporary approach to obturation of the root canal system is provided, including advice for those difficult cases such as managing obTuration of a canal with a wide open apex.
Abstract: This article will provide an overview of the rationale behind taking a contemporary approach to obturation of the root canal system. It will outline a broad range of obturation materials including those traditionally used and newer, advanced ones that are now available that have active physical and biological properties. Obturation techniques will be described in detail, including advice for those difficult cases such as managing obturation of a canal with a wide open apex. Assessment of obturation will also be discussed, considering those factors which affect outcome of root canal treatment.
TL;DR: Primary care dental teams are in an important position to become actively engaged in promoting oral health equity, both for their own patients and the wider community.
Abstract: A recent important report endorsed by several prestigious and influential medical and dental organisations has outlined what health professions can do to reduce health inequalities. Despite overall improvements in oral health in recent decades, there are unacceptable inequalities in oral diseases. Urgent action is needed to reduce these unfair and unjust oral health inequalities that exist across society. Primary care dental teams are in an important position to become actively engaged in promoting oral health equity, both for their own patients and the wider community. This paper highlights practical ways that dental teams can become involved in action to reduce oral health inequalities.
TL;DR: To deliver the knowledge and skills required to equip undergraduate students for practice is a significant responsibility; graduates must be familiar with the diagnosis and treatment of pulpal and periradicular diseases and the preservation and restoration of pulpally compromised teeth.
Abstract: To deliver the knowledge and skills required to equip undergraduate students for practice is a significant responsibility; graduates must be familiar with the diagnosis and treatment of pulpal and periradicular diseases and the preservation and restoration of pulpally compromised teeth. A greater understanding of the microbiological processes involved in endodontics and developments in instruments and materials have transformed our approaches to root canal treatment. Information technology has revolutionised certain aspects of education and has had an effect on endodontic teaching. Dental graduates will be expected to treat an increasingly elderly population and will enter a climate in which remuneration for root canal treatment could have a significant effect on the number of cases treated and the pattern of referral. Teachers of endodontics at the majority of dental schools are taxed by competing demands for time in packed curricula, a lack of availability of natural teeth for classroom exercise and a lack of suitable patients. The debate as to whether endodontics should be a specialist subject in its own right has rumbled on for three decades. Compared with the situation in the 1970s, there are now well defined curricula guidelines to which those involved in teaching can refer and map teaching in their schools against agreed norms. These create the potential for students to graduate with the knowledge and skills at a sound level of competence to carry out endodontic procedures and with a deeply engrained understanding of the need for continuing professional development.
TL;DR: Salivary flow rates in B MS patients are decreased further by medication usage whose side effects include dry mouth, which suggests that hyposalivation may play a role in causing dry mouth in BMS, which may respond to treatment with a sialogogue.
Abstract: Background Burning mouth syndrome (BMS) is a chronic condition of burning of the tongue and oral mucosa. It is often accompanied with complaints of xerostomia, although it is unknown whether the dryness is a sensory change similar to the burning sensation or due to hyposalivation. To determine whether there is change in salivary flow rate, whole salivary flows were measured in BMS patients. Methods A clinical ambispective study was conducted. Patients' clinical files were reviewed for stimulated and unstimulated whole salivary flow. Patients were divided into four groups based on diagnosis into Sjogren's syndrome (SS), BMS, BMS taking oral drying medications (BMS-med), and control (C). Whole stimulated (SF) and unstimulated flow (USF) measurements were collected and compared among groups. Data were analysed with ANOVA, Levene's test, Tukey's test and Games-Howell test. Results Twenty SS, 22 BMS, 24 BMS-med and 15 C were included in the study. SF was significantly lower in SS (0.59 ml ± 0.36) compared with BMS (1.56 ml ± 0.65, p <0.001), BMS-med (1.44 ml ± 0.64, p <0.001) and C (2.32 ml ± 1.06, p = 0.001). USF was significantly lower in SS (0.12 ml ± 0.10) compared with BMS (0.30 ml ± 0.18, p = 0.002), BMS-med (0.27 ml ± 0.21, p = 0.022) and C (0.52 ml ± 0.26, p <0.001). SF was not significantly different between BMS and C (p = 0.172) and BMS-med and C (p = 0.096). Both BMS and BMS-med had significantly lower USF compared with C (p = 0.040 and p = 0.018 respectively). SF in BMS was not significantly affected by number of oral drying medications (p = 0.254); however, USF was significantly lower with two or more oral drying medications (0.13 ml ± 0.07) compared with one oral drying medication (0.32 ml ± 0.22) (p = 0.034). Conclusion BMS patients have statistically significant decreased unstimulated salivary flow rate with non-statistically significant decreased stimulated flow rate. Salivary flow rates in BMS patients are decreased further by medication usage whose side effects include dry mouth. This suggests that hyposalivation may play a role in causing dry mouth in BMS, which may respond to treatment with a sialogogue.
TL;DR: The prevalence of moderate to severe periodontitis in an ancient British cohort was markedly decreased when compared to the prevalence in modern populations, underlining the potential importance of risk factors such as smoking and diabetes in determining susceptibility to progressive periodontococcal disease inmodern populations.
Abstract: Objective The aim of this study was to investigate the prevalence of moderate to severe periodontitis in an ancient British cohort c. 200-400 AD.
Design Observational study to assess periodontal and other oral disease parameters.
Setting Natural History Museum, London.
Subjects and methods 303 skulls from a Romano-British burial site in Poundbury, Dorset were examined for evidence of dental disease.
Main outcome measures The primary outcome measure was presence of moderate to severe periodontitis. Secondary outcomes included: amount of horizontal bone loss; prevalence of ante-mortem tooth loss; and presence of other dental pathologies.
Results The overall prevalence of moderate to severe periodontitis was just greater than 5%. The prevalence rate remained nearly constant between ages 20 to 60, after which it rose to around 10%. The number of affected teeth increased with age. Horizontal bone loss was generally minor. Caries was seen in around 50% of the cohort, and evidence of pulpal and apical pathology was seen in around 25%.
Conclusions The prevalence of moderate to severe periodontitis was markedly decreased when compared to the prevalence in modern populations, underlining the potential importance of risk factors such as smoking and diabetes in determining susceptibility to progressive periodontitis in modern populations.
TL;DR: The article emphasises the dental team's role in promoting behaviour change in their patients aimed at reducing smoking and obesity levels, by promoting healthy nutrition and exercise.
Abstract: This article outlines the European Federation of Periodontology's (EFP) manifesto Periodontal Health for a Better Life which was informed by the first joint EFP/American Academy of Periodontology workshop on periodontitis and systemic health. The EFP manifesto calls upon the dental profession to engage in screening and providing preventive advice to patients who are at risk of common chronic diseases and conditions such as cardiovascular disease, diabetes and cancer. In particular, the article emphasises the dental team's role in promoting behaviour change in their patients aimed at reducing smoking and obesity levels, by promoting healthy nutrition and exercise. The chairman of the National Association of Primary Care Medicine, Dr Charles Alessi, has strongly endorsed this model and highlighted the important opportunities offered by a capitation-based new contract for the dental team to engage fully in preventive medicine in support of medical colleagues and in the best interests of public health and patients across England.
TL;DR: The findings of this study may offer clarity on the essential attributes required by dental graduates upon entry into foundation training in the South West region of England.
Abstract: Aims The aims of this study were to articulate the concept of preparedness of dental graduates for foundation training programme in the United Kingdom and identify the essential attributes of preparedness. Methods A qualitative approach using semi-structured interviews was used to explore the concept of preparedness. The study was carried out in the South West region of England. Participants were recruited from a range of stakeholders in dental education and foundation training using purposive sampling. Participants were recruited using email through appropriate professional channels. Stakeholders included dental students (DS), dental academics (DA), foundation dental practitioners (FDP), foundation trainers (FT), general dental practitioners (GDP) and a postgraduate dental deanery representative (DDR). Interviews were transcribed verbatim and data were imported into NVivo 9 and analysed thematically. Results Sixteen interviews were carried out with representation from all stakeholder groups. Participants expressed their views on a range of issues related to the preparedness of dental graduates. Conclusions This study provides useful insights into the concept of preparedness as perceived by the stakeholders. The findings of this study may offer clarity on the essential attributes required by dental graduates upon entry into foundation training.
TL;DR: What can the study of ancient teeth tell us about the dietary habits of the authors' ancestors?
Abstract: What can the study of ancient teeth tell us about the dietary habits of our ancestors? Diet plays a prominent role in the organisation and evolution of human cultures and an increasingly diverse array of analytical techniques are available to help reconstruct diet in ancient populations. Dental palaeopathology is particularly important as it can provide direct evidence of the type of diet an individual consumed during life. Heavy occlusal tooth wear is the most frequent condition recognisable and an examination of both macro and microscopic patterns of wear can establish the differences between the hard fibrous diet typical of a hunter-gatherer, and a diet primarily consisting of softer plant foods consumed by an agriculturist. The distributions of trace elements and stable isotopes in food webs make it possible to use them as natural tracers of foodstuffs. Through a consideration of photosynthetic pathways, the ratios of the different stable isotopes of carbon and nitrogen can determine which specific groups of plants and animals were dominant in the food chains of various populations - a fact that has been used to trace the spread of agriculture in ancient civilisations.
TL;DR: Dentistry has been slower at systematically considering how patient safety can be improved, but strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry.
Abstract: Patient safety has always been important and is a source of public concern. Recent high profile scandals and subsequent reports, such as the Francis report into the failings at Mid Staffordshire, have raised those concerns even higher. Mortality and significant morbidity associated with the practice of medicine has led to many strategies to help improve patient safety, however, with its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved. Recently, several organisations, researchers and clinicians have discussed the need for a patient safety culture in dentistry. Strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry.
TL;DR: Clear and precise guidelines to manage patients with NaOCl injury are formulated following a literature review and considering the own experience.
Abstract: Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.
TL;DR: The majority of respondents supported the concept of medical screening in a dental setting and were willing both to have screening tests and discuss their results with the dental team.
Abstract: Aim To determine the attitudes of patients attending routine appointments at primary care dental clinics and general dental practices towards the possibility of chair-side screening for medical conditions, including diabetes, in the dental setting. Methods A brief, anonymous, self-administered questionnaire distributed to adult patients (≥18 years) attending 2 primary care dental clinics and 16 general dental practices in South-West England. Results One hundred and ninety-seven completed questionnaires were received from patients at primary care dental clinics and 429 from general dental practice patients. Overall, 87% of respondents thought that it was important or very important that dentists screened patients for medical conditions such as diabetes; 79% were very willing to let a dental team member carry out screening. The majority indicated willingness to be screened for various medical conditions during a visit to the dentist, with significantly higher proportions of respondents in the primary care clinics indicating willingness (hypertension: 83% vs 74%; heart disease: 77% vs 66%; diabetes 82% vs 72% [all p <0.02]). Nearly two thirds of primary care clinic respondents and over half of general practice patients indicated that they would be willing to discuss test results with the dental team. Overall, 61% had never knowingly been screened or tested for diabetes; 20% reported that they had been tested within the previous 12 months. Conclusion The majority of respondents supported the concept of medical screening in a dental setting and were willing both to have screening tests and discuss their results with the dental team. Patient acceptance is paramount for successful implementation of such screening programmes.
TL;DR: Laptops and smartphones are the most popular choice of device and desktop computers are the least popular depending on the year in the course and applications on smartphones are very popular and instant messaging is an upcoming form of communication for students.
Abstract: Aim The aim of this study was to understand how new mobile technologies, such as smartphones and laptops, are used by dental students. Materials and methods A questionnaire was distributed to undergraduate dental students from years 1 to 4, at the University of Birmingham Dental School. Questionnaires were completed between February and April 2013. Results Two hundred and seventy questionnaires were completed. Laptops 55% (145) and smartphones 34% (88) were the most popular choice of device for connecting to the net and searching information. Laptops were preferred in first and second year. Students in year 3 preferred mobile phones, and by year 4 the use of mobile phones and laptops was similar. The top two application ideas chosen by students as the most useful on their smart phones were a dictionary for dental education (56%) and multiple choice questions (50%). Students who chose smartphones as their first choice or second choice of device strongly agreed that having the Internet on their smartphones had a positive impact on their dental education (55%). With laptops (48%), students preferred to be at home when using them while for smartphones (31%) they used them anywhere with a connection. E-mail (47%) and social networks (44%) were the top two Internet communication tools used most on laptops. Instant messaging was popular on smartphones (17%). Conclusions Depending on the year in the course, laptops and smartphones are the most popular choice of device and desktop computers are the least popular. Applications on smartphones are very popular and instant messaging is an upcoming form of communication for students.