Showing papers in "British Dental Journal in 2018"

A systematic approach.

Abstract: An old saying in the text i le wet process ing industry i s \"wel l prepared-half dyed.\" This s tatement i s not quoted to imply that the majori ty of problems which occur in dyeing is due to inadequate preparation, but that in many cases problems which are not detected in preparation do lead t o f a u l t y d y e i n g s . Grunig [l] breaks down the percentage of defects in text i le wet process ing according to or ig in as fo l lows:

Erosive tooth wear – a review on global prevalence and on its prevalence in risk groups

Abstract: Erosion is a common phenomenon in the general population of developed countries. However, due to variations in indices, sample sizes and general study designs, it is difficult to compare the various studies and to estimate actual global prevalence. Therefore, the aim of this present paper is to give a narrative overview on the data available on the global prevalence of erosion. Information on prevalence is not available from each country; in particular, data from Asia, Africa, South America, North America and large parts of South-Eastern Europe are unavailable. There is a large variation in global prevalence ranging between 0 and 100%. Calculating a rough mean from the data available, a mean prevalence in deciduous teeth between 30% and 50% and in permanent teeth between 20% and 45% can be estimated. There seems to be a gender difference and an increase in prevalence with age. Prevalence studies on erosion risk groups show comparable variation. Only in patients with gastro-oesophageal reflux disease (GORD) and eating disorders associated with vomiting can a clear impact on erosion prevalence be found. In people who consume acidic foods and drinks, a higher risk can be found for some specific comestibles. However, there is a lack of controlled epidemiological studies, making it difficult to generalise. There is a clear need for well-designed studies on this issue.

The changing epidemiology of oral cancer: definitions, trends, and risk factors

Abstract: Objective This review has three objectives, namely: (i) to discuss how oral cancer is and ought to be defined and recorded; (ii) to present up-to-date data on the incidence burden of the disease in the four countries of the UK, and review recent analyses of trends in the disease; and (iii) to summarise recent evidence on risk factors of the disease. Methods Cancer definitions were clarified by the International Classification of Diseases accounting for anatomical and aetiological differences; descriptive epidemiology included international / UK literature review and information requests for incidence data from the UK cancer registries (2000-2016); analytical epidemiology focused on reviewing the findings of the International Head and Neck Cancer Epidemiology (INHANCE) consortium, which has pooled data from multiple case-control studies providing the best estimates of risk factors. Results Emerging evidence of the role played by risk factors in different anatomical sites means that oral cavity cancer and oropharynx cancer should be considered distinct disease entities – and a standardised attribution of anatomical subsites will be helpful in ensuring consistency in how data are presented. In 2016, over 3,700 people were diagnosed with oral cavity cancer and over 3,500 people were diagnosed with oropharyngeal cancer in the UK. Incidence of oropharyngeal cancer is rapidly rising across the UK. Rates of oral cavity cancer are higher in Northern Ireland and higher still (and relatively stable) in Scotland, but rising in England and Wales. INHANCE data show that while the consumption of alcohol and tobacco are the prime risk factors for oral cavity and oropharyngeal cancers, they provide greater certainty in the preventive benefits of reducing these risk factors. The role played by other factors such as low socioeconomic status, genetics, oral health, and human papillomavirus (only for oropharyngeal cancer) have become clearer. Conclusions This epidemiology provides a strong foundation for designing and managing both population and individual oral cavity and oropharyngeal cancer control strategies.

The oral microbiota – a mechanistic role for systemic diseases

Abstract: Human oral microbiota is the ecological community of commensal, symbiotic, and pathogenic microorganisms found in the oral cavity. Oral microbiota generally exists in the form of a biofilm and plays a crucial role in maintaining oral homeostasis, protecting the oral cavity and preventing disease development. Human oral microbiota has recently become a new focus research for promoting the progress of disease diagnosis, assisting disease treatment, and developing personalised medicines. In this review, the scientific evidence supporting the association that endogenous and exogenous factors (diet, smoking, drinking, socioeconomic status, antibiotics use and pregnancy) modulate oral microbiota. It provides insights into the mechanistic role in which oral microbiota may influence systemic diseases, and summarises the challenges of clinical diagnosis and treatment based on the microbial community information. It provides information for noninvasive diagnosis and helps develop a new paradigm of personalised medicine. All these benefit human health in the post-metagenomics era.

Molar incisor hypomineralisation (MIH) - an overview.

Abstract: Recent data indicates that molar-incisor hypomineralisation (MIH) is a frequently - encountered dental condition worldwide. The condition could be associated with dental complications that might affect patients' quality of life as well as create treatment challenges to dentists. The affected teeth are more prone to caries and post-eruptive enamel breakdown, therefore, it is believed that this condition might be responsible for a substantial proportion of childhood caries since the condition has high prevalence. MIH is common, and as such it should be diagnosed and managed in primary care wherever possible. Early diagnosis can lead to more effective and conservative management. This article aims to highlight different aspects related to MIH, from its prevalence to treatment options in young patients.

Sleep bruxism: an overview for clinicians.

Abstract: Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support Sleep bruxism has previously been viewed as a dysfunctional movement or pathological condition, whereas it is now accepted as a centrally controlled condition with various systemic risk factors It has been postulated that sleep bruxism may have a protective role during sleep, for example in relation to airway maintenance or in stimulating saliva flow A diagnosis of sleep bruxism may be made via patient report and clinical interview, clinical examination, intraoral appliances or recording of muscle activity Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of bruxism Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity Irreversible occlusal adjustments have no basis in evidence in the management of bruxism Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of bruxism, but concerns have been raised regarding possible adverse effects Dentists should be aware of the potential aetiology, pathophysiology and management strategies of sleep bruxism

Beyond Streptococcus mutans: clinical implications of the evolving dental caries aetiological paradigms and its associated microbiome.

Abstract: Aetiological concepts of dental caries have evolved over the years from being considered as a disease initiated by nonspecific microorganisms, to being regarded as an 'infectious' disease caused by specific bacteria, to the current paradigms that emphasise a 'mixed bacterial-ecological approach' as being responsible for lesion initiation and pathogenesis. These aetiological paradigms are not just intellectual concepts but have important implications on how clinicians manage this age-old disease in the twenty-first century. Despite evidence-backed recommendations for adopting more biological measures to counter the disease, a significant proportion of dentists continue following traditional caries management guidelines in their daily clinical practice. This paper will review the evolving dental caries aetiological concepts and highlight the current evidence for adopting a more ecological approach to caries prevention, risk assessment, and treatment.

A guide to managing tooth wear: the Radboud philosophy

Abstract: This paper explains a conservative, pragmatic and minimally invasive intervention concept for the treatment of severe tooth wear patients based on the Radboud Tooth Wear Project in the Netherlands. Guidelines and flowcharts for management of severe tooth wear patients and rehabilitation in increased vertical dimension of occlusion are presented. We concluded that: (a) Restorative treatment is not always indicated, even for patients with severe tooth wear. (b) If the patient has no complaints, counselling and monitoring is probably the best option. (c) Minimally invasive and adhesive restorative strategies are preferred when severe tooth wear patients are to be treated in increased vertical dimension, especially when young patients are involved. (d) Clinical evidence for a suitable restorative treatment protocol is limited to five-year follow up for direct composites. This material seems to be suitable for rehabilitation in increased vertical dimension on the middle long term. Clinical results for indirect techniques are not available yet. (e) Restorations, including those that are considered 'definitive' may prove to have a limited lifetime in patients with severe tooth wear due to bruxism and erosion. Explanation of the possible treatment options and expected complications should be included in the informed consent.

The ins and outs of root resorption.

Abstract: Root resorption is a poorly understood phenomenon and is often misdiagnosed and, as a result, inappropriately treated. The aim of this paper is to provide a practical guide for diagnosis of root resorption lesions using a simple classification, and to describe the principles of management of these resorptive defects in everyday practice.

Interviews and focus groups in qualitative research: an update for the digital age.

Abstract: Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

The ultimate guide to restoration longevity in England and Wales. Part 8: Canine teeth: time to next intervention and to extraction of the restored tooth

Abstract: Aim It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. Methods A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Conclusions Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.

Technology: Artificial intelligence.

Abstract: Sir, artificial intelligence (AI) has been used in a variety of ways in healthcare. These include detecting gastric cancer in endoscopic images, estimating the impact of human papillomavirus types in influencing the risk of cervical dysplasia recurrence, classifying skin cancer, identifying microbial volatile organic compound signatures, detection of fractures, and many more. AI can serve as a useful modality in diagnosis and treatment of lesions of the oral cavity and can be employed in screening and classifying suspicious altered oral mucosa undergoing premalignant and malignant changes. The advantage would be no observation fatigue, and even minute changes at single pixel level can be detected which might go unnoticed by the naked eye. The analysis of omics data and individual medical profiles by AI might accurately predict a genetic predisposition for oral cancer for large populations. Further, personalised medicine, long-term treatment outcomes, recurrences and survival of oral cancer patients might be specifically calculated by AI algorithms. With respect to resection surgery, the intraoperative pathological diagnosis would be real-time and the margin accuracy might be comparable to or even better than that of frozen sections, as hypothesised by Zhang et al.1 Analogous to the findings of Palma et al.,2 AI might detect oral microbial volatile organic compound signatures which has potential applications in oral microbiology and periodontal medicine practice. AI when integrated with endodontics, might biomechanically prepare the root canals with precision. The analysis of digital slides by AI might result in more accurate detection of occult metastasis and comparative analysis of immunohistochemistry and other techniques. More importantly, subjective and observer bias might be eliminated as perceived in the diagnosis of epithelial dysplasia. Digital imaging methods integrated with AI might improve radio-diagnosis and reduce observer fatigue. Incorporation of AI in teaching and learning process can dramatically improvise the way student perceive knowledge. AI can contribute from the designing of meaningfully differentiated curriculum to error free evaluation pattern (humans are sometimes biased). Future AI-based dental education can significantly reduce the cost of education and burden on educators. B. Majumdar, S. C. Sarode, G. S. Sarode, India S. Patil, Saudi Arabia

The pathology of oral cancer

Abstract: The term 'oral cancer' describes a range of malignancies that may arise in and around the oral cavity. Over 90% of such lesions are squamous cell carcinomas, but even these may be divided into different entities based on site, aetiology and prognosis. In particular, squamous carcinomas in the oral cavity (oral cancer) should be regarded as a different disease to carcinomas arising in the oropharynx. Oropharyngeal cancer is associated with infection by human papillomavirus (HPV) and shows different clinical and histological features. This short review summarises the pathology of oral and oropharyngeal cancer, and describes some of the main prognostic factors that pathologists use to assist clinicians in planning appropriate management.

Prevention of erosive tooth wear: targeting nutritional and patient-related risks factors.

Abstract: This article provides an overview of the nutritional and patient-related risk factors involved in the aetiology of erosive tooth wear (ETW) and the preventive strategies to counteract them. The first step is to diagnose clinical signs of ETW and to recognise causal factors. Low pH and high buffer capacity of foods/drinks are the major risk factors, while the calcium concentration is the main protective factor. Reduction of frequency of consumption and contact time of erosive foods/drinks with the teeth, use of straws appropriately positioned and consumption of dairy products are advisable. Oral hygiene has a role in the development of ETW, however, postponing toothbrushing is not clinically advisable. In cases of drug abuse, chronic alcoholism, GERD or bulimia, the patient must be referred to a doctor. Immediately after vomiting, patients might be advised to rinse the mouth. Saliva has an important protective role and patients with reduced salivary flow can benefit from the use of chewing gum. Recent studies have focused on improving the protective capacity of the acquired pellicle as well as on the role of protease inhibitors on dentine erosion. However, the degree of evidence for these preventive measures is low. Clinical trials are necessary before these measures can be recommended.

The environmental impact of dental amalgam and resin-based composite materials

Abstract: Direct-placement dental restorative materials include dental amalgam, glass ionomer, resin-modified glass ionomer, compomer and resin-based composite (RBC). The choice of restorative material is determined by its ability to restore the structure and/or the aesthetic appearance of the dentition and to impart a net therapeutic value. In this way, the most appropriate material system is chosen to manage each particular clinical situation in the most effective manner. The most commonly used direct-placement materials in everyday modern dentistry are dental amalgam and resin-based composites. To date, concerns about the environmental impact from the use of dental materials has focused on dental amalgam and mercury release. It is now evident that the continued use of dental amalgam is time-limited on the basis of environmental pollution as recommended by the Minamata Treaty. The recommendations include a planned phase-down of use of dental amalgam with an anticipated complete phase-out by 2030. The environmental impact of other restorative dental materials deserves further consideration. This article provides a detailed overview of the environmental issues associated with the use of dental amalgam, the potential environmental issues associated with the alternative resin-based composite restorative materials and to consider recommendations for further research.

Raising awareness of oral cancer from a public and health professional perspective.

Abstract: Low public awareness of oral cancer and delays in symptomatic patients presenting to health services have been identified as contributing factors to poor survival rates. In order to promote diagnosis and treatment of oral cancer at an earlier stage, public awareness campaigns have been recommended, encouraging those with signs and symptoms to attend primary care services at an earlier stage. This article provides an overview of the evidence of effectiveness of interventions aimed at raising cancer awareness and explores the use of mass media for health behaviour change. The use of awareness campaigns to promote earlier diagnosis of oral cancer is also explored from both a patient and health professional perspective. The findings of the overview suggest that while awareness raising campaigns can increase knowledge of the disease and attendance at health services in the short-term, those at lesser risk often respond, and evidence of longer-term impact is very limited. The translation of knowledge into behaviour change is likely to require a more comprehensive, longer-term, multi-faceted approach, acknowledging the social determinants of health and health behaviour theory. More work is required to understand what needs to be included in campaigns to make them effective. Availability and access to appropriately trained and informed primary care personnel is important, particularly for high-risk groups. This is relevant for: supporting those with signs and symptoms to attend services; promoting opportunistic screening; enabling referral of patients to secondary care in a timely manner; and for provision of advice on the major risk factors associated with oral cancer.

Assessment of anxiety.

Abstract: Sir, mortality from general anaesthesia declined greatly in the second half of the twentieth century, therefore any death from dental general anaesthesia (DGA) received even greater condemnation. This led to the publication of what was known as ‘The Poswillo report’ in 1990 which recommended DGA should be avoided wherever possible and other practices utilised. DGA use declined and sedation increased; however, deaths still occurred. Therefore, in 2000 the Department of Health published ‘A conscious decision’2 which recommended ‘General anaesthesia for dental treatment should only take place in a hospital setting’. It also recommended ‘better data must be obtained on fatal and non-fatal complications’. Before ‘A conscious decision’, DGA activity was recorded by the Dental Practice Board and from this data we know there were approximately 300,000 patients who underwent DGAs each year in the 1990s, with two patients dying each year. The data available to us now is taken from hospital episode statistics which don’t record whether general anaesthesia was used, so estimates are made from the procedures carried out. The number of surgical extractions, simple extractions and ‘excision of dental lesion of jaw’ procedures done in the four nations was 221,574 in 2017;3 however, the number of these that required GA is not known. What effect has this change in practice had? It was the author’s aim to find the number of DGA-related deaths since 2000. Freedom of Information (FOI) requests were sent via email to each health board or trust in the UK requesting ‘the number of deaths per year since 2000 from general anaesthesia for dental procedures’. There was a total of 15 deaths (see Table 1). However, even these could not be directly attributed to the DGA as the death was linked with the care episode, not a specific cause. Also the interpretation of the FOI may be subjective. If this data is to be accepted then there has been a decrease in the number of deaths per year from DGA since the 1990s (from 2 per year to 0.88). However, given the variability in responses the study highlights the lack of knowledge about: a) The number of DGAs carried out and b) The morbidity and mortality rate as a result of DGA.

National clinical guidelines for the management of unerupted maxillary incisors 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 management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis.

Abstract: Introduction Oral bisphosphonates are the most commonly prescribed anti-resorptive drugs used in the treatment of osteoporosis, but osteonecrosis of the jaw is a serious complication. The early diagnosis of this destructive side effect is crucial in preventing excessive bone loss, pain and infection.Objective To aid dental practitioners in the early identification of bisphosphonate-related osteonecrosis of the jaw.Method A scoping review was carried out.Data sources We searched MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source (DOSS), Proquest Dissertation and Theses Search, to identify references that described clinical and radiological findings in medication-related osteonecrosis of the jaw (MRONJ).Data selection Nineteen references mentioned the earliest radiological changes in MRONJ with a description of the observations and were included in the analysis.Data synthesis The radiographic signs included osteosclerosis/lysis, widening of the periodontal ligament and thickening of the lamina dura and cortex. To assess the quality of original data on which recommendations had been made, these 19 studies were subjected to a quality appraisal.Conclusion Using bone exposure as a criterion for diagnosis of MRONJ, leads to delayed diagnosis and a poor response to treatment. In those patients at risk of bone exposure with MRONJ, insufficient information is present in the literature to allow the general dental practitioner to reliably identify the radiographic features indicating imminent bone exposure. A well-designed prospective study is needed.

Screening for mouth cancer: the pros and cons of a national programme.

Abstract: The paper highlights the pros and cons of a national programme for screening for oral cancer. It provides an overview of screening methods and the metrics used to evaluate a screening programme. It then reviews the evidence for mouth cancer screening against the criteria of the United Kingdom National Screening Committee.

Dental pulp stem cells in regenerative medicine.

Abstract: The mesenchymal stem cells (dental pulp stem cells; DPSC) found inside teeth represent a significant future source of stem cells for regenerative medicine procedures. This review describes the ontogeny of DPSC; the laboratory processing and collection of DPSC; the immuno-cytochemical characterisation of DPSC; the differentiation between adult DPSC and DPSC obtained from exfoliated deciduous teeth (SHED) and their potential use in regenerative medicine procedures in the future both in dental and general medical applications.

Altmetric analysis of contemporary dental literature

Abstract: It has been reported that Altmetrics are significantly correlated with citation and download.6 The findings of a large-scale investigation showed robust evidence that six of the Altmetric data resources (tweets, Facebook wall posts, research highlights, blog mentions, mainstream media mentions and forum posts) were associated with the number of citations, particularly in medical and biological sciences.7 Of more interest, medical research funders and charities (for example, the Wellcome Trust and John Templeton Foundation) were drawn to Altmetric data.8-10 A Google trend analysis shows that the popularity of Altmetrics has increased dramatically since 2012 in comparison with bibliometrics (Fig. 1). The Altmetric data for 2014 and 2015 dental literature have been analysed previously, with the mean Altmetric score of 50 top dental articles in 2014 reported as 69.5 ± 73.3 The British Dental Journal (48%) and the Journal of Dental Research (16%) had the maximum number of top articles among dental journals. In 2015, all published dental literature was analysed, and the British Dental Journal gained Introduction

Early diagnosis and daily practice management of erosive tooth wear lesions.

Abstract: This paper explores some of the most relevant questions faced by dental practitioners when diagnosing early erosive tooth wear (ETW) and implementing non-operative management of this condition over time. It focuses on the identification of clinical signs and common locations of ETW lesions, the assessment of individual risk and the implementation of non-operative management strategies, aiming to arrest and/or reduce the rate of ETW progression and avoid its advance to pathological stages. To this end, we present a novel and comprehensive approach that considers the whole dentition of patients rather than individual groups of teeth or dental surfaces only, illustrating it with a series of clinical photographs. Dental practitioners may find this approach particularly helpful as it closely simulates the clinical examinations of patients of all age groups carried out in daily practice. The clinical signs of early ETW lesions are subtle and often not perceived as relevant by unaware clinicians. However, the early diagnosis and implementation of non-operative management strategies, especially at younger ages, is fundamental for the proper control of ETW over time.

Space maintainers in the primary and mixed dentition - a clinical guide.

Abstract: This paper describes different types of space maintainers and the clinical situations where they may be useful, for example, when primary teeth have been lost prematurely. It serves as a clinical guide for practitioners on the best types of space maintainers to use and on the clinical uses of space maintainers in preventing undesirable tooth movements and resulting loss of arch length.

The treatment need and associated cost of erosive tooth wear rehabilitation - a service evaluation within an NHS dental hospital.

Abstract: The treatment need and associated cost of erosive tooth wear rehabilitation – a service evaluation within an NHS dental hospital

Are there good reasons for the fluoride labelling of food and drink

Abstract: This opinion piece highlights the importance of controlling systemic fluoride intake from food and drink in early childhood to minimise risk of dental fluorosis whilst maximising caries prevention; the wide range of fluoride contents found in a study of commercially-available food and drinks; and the need for comprehensive fluoride labelling on food and drink products in the UK, particularly those used by infants and young children.

The role of the diet in tooth wear.

Abstract: An acidic diet has been associated with erosive tooth wear. However, some people who consume dietary acids develop erosive tooth wear and some do not. This review paper provides an overview of the risk factors of dietary acid consumption which increase the likelihood of developing severe erosive tooth wear. Increased frequency of dietary acid consumption, particularly between meals appears to be the predominant risk factor. However, habitually drinking acidic drinks by sipping them slowly or swishing, rinsing or holding acidic drinks in the mouth before swallowing will also increase risk of progression. Consuming fruit over long time periods at a single sitting and dietary acids being served at increased temperatures have also been implicated. Additions of fruit or fruit flavourings to drinks and regular consumption of vinegars, pickles, acidic medications or acidic sugar-free sweets are potential hidden risk factors that should be discussed with patients at risk of erosive tooth wear progression. Behaviour change is difficult to achieve but specific, targeted behavioural interventions and offering alternatives may increase success.

The ultimate guide to restoration longevity in England and Wales. Part 10: key findings from a ten million restoration dataset.

Abstract: Introduction This paper defines key points from a ten million restoration dataset in order to compare and contrast the data from the previous nine papers, identifying common themes and/or differences in the factors affecting the survival of restored teeth to next intervention or extraction. Aim It is the aim of this paper to present data on the survival of restorations in teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss key findings regarding this. Methods A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the key findings with regard to recorded intervals between placing a restoration in any tooth and re-intervention on the tooth, with the size of the dataset also permitting examination of the time to extraction of the restored tooth. Results Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 13,896,048 tooth restorations were included in the analysis. With regard to time to re-intervention, overall, between 32% and 42% of restorations, depending on tooth type, had survived at 15 years, and with regard to time to extraction of the restored tooth, the range was from 77.8% to 84.2%. Conclusions The analysis confirms that larger restorations of all types and in all types of teeth generally performed less well than smaller restorations. Crowns perform better in time to re-intervention than direct restorations, but worse, particularly for younger patients, in time to extraction. Patient treatment history, measured as the average annual spend on treatment, is a major factor in the survival of restored teeth, both to re-intervention and to extraction. The greater the spend, the worse the survival. Regarding dentists, there is little difference in the survival of restorations placed by dentists of different gender, but dentists' age has been shown to play a part in the present investigation, with restorations placed by younger dentists performing better for all types of restoration except crowns. For direct restorations, the older the patient the poorer the survival of the restoration, whether to re-intervention or to extraction. The prognosis of a tooth which receives a root filling in the same course of treatment as the other restoration is much poorer than for teeth without such a root filling.

Perceived confidence and experience in oral surgery among final year undergraduate students in a UK dental school.

Abstract: Perceived confidence and experience in oral surgery among final year undergraduate students in a UK dental school