Showing papers in "Primary dental care : journal of the Faculty of General Dental Practitioners in 2007"

Cardiovascular and oral disease interactions: what is the evidence?

Abstract: This paper reviews the evidence for the interaction of oral disease (more specifically, periodontal infections) with cardiovascular disease. Cardiovascular disease is a major cause of death worldwide, with atherosclerosis as the underlying aetiology in the vast majority of cases. The importance of the role of infection and inflammation in atherosclerosis is now widely accepted, and there has been increasing awareness that immune responses are central to atherogenesis. Chronic inflammatory periodontal diseases are among the most common chronic infections, and a number of studies have shown an association between periodontal disease and an increased risk of stroke and coronary heart disease. Although it is recognised that large-scale intervention studies are required, pathogenic mechanism studies are nevertheless required so as to establish the biological rationale. In this context, a number of hypotheses have been put forward; these include common susceptibility, inflammation via increased circulating cytokines and inflammatory mediators, direct infection of the blood vessels, and the possibility of cross-reactivity or molecular mimicry between bacterial and self-antigens. In this latter hypothesis, the progression of atherosclerosis can be explained in terms of the immune response to bacterial heat shock proteins (HSPs). Because the immune system may not be able to differentiate between self-HSP and bacterial HSP, an immune response generated by the host directed at pathogenic HSP may result in an autoimmune response to similar sequences in the host. Furthermore, endothelial cells express HSPs in atherosclerosis, and cross-reactive T cells exist in the arteries and peripheral blood of patients with atherosclerosis. Each of these hypotheses is reviewed in light of current research. It is concluded that although atherosclerotic cardiovascular disease is almost certainly a multifactorial disease, there is now strong evidence that infection and inflammation are important risk factors. As the oral cavity is one potential source of infection, it is wise to try to ensure that any oral disease is minimised. This may be of significant benefit to cardiovascular health and enables members of the oral health team to contribute to their patients' general health.

Do dental anxiety questionnaires raise anxiety in dentally anxious adult patients? A two-wave panel study.

Abstract: ObjectiveTo test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire.Basic research designPatients w...

Infection control: a survey of UK special care dentists and dental care professionals.

Abstract: AimTo determine attitudes to and practice of infection control among practitioners involved in special care dentistry.MethodsA questionnaire on the issues of decontamination and infection control w...

An analysis of the out-of-hours demand and treatment provided by a general dental practice rota over a five-year period.

Abstract: ObjectiveTo obtain information about the frequency of call-outs, relative frequency of different types of dental emergencies that presented, and treatment provided between 1999 and 2003 by an out-o...

Localised periodontitis associated with an ectopic orthodontic separator.

Abstract: A case of localised periodontitis associated with a subgingival orthodontic separator is presented. The presence of this object was related to quite severe periodontal breakdown around an upper right first premolar tooth in an otherwise unsusceptible individual.

A survey to investigate shortfalls in the dental care professional (DCP) workforce in South Yorkshire in 2004.

Abstract: AimTo determine the composition of the dental care professional (DCP) workforce in South Yorkshire, the existence of any training requirements, and future intentions and motivations relating to the...

Perceptions and attitudes to a fundamental reform of general dental services in Wales.

Abstract: BackgroundThe greatest reform of state-funded dental care in England and Wales, since the inception of the National Health Service (NHS) in 1948, occurred on 1st April 2006. It encompassed the diss...

A comparison of the attitudes and beliefs of professional rugby players from one club and parents of children playing rugby at an adjacent amateur club to the wearing of mouthguards.

Abstract: OBJECTIVE: To assess the knowledge that professional rugby players have with regard to the benefits of wearing an oral mouthguard and the importance that they give to wearing the appliance during play, then to compare these views with those of the parents of children who are beginning to play the sport. DESIGN: Questionnaires and covering letters were sent to the parents of children who played rugby at Malton & Norton Rugby Union Football Club (RUFC), which has teams for all age groups from under 7-8 years to adult. Similar questionnaires were sent to the first team squad of Leeds Tykes, a Zurich Premiership rugby union club. The questionnaires asked a series of questions on the use of mouthguards and knowledge of their importance in the prevention of injuries. RESULTS: The overall response rate was 76%. Seventy-four of the 100 questionnaires sent to the parents and 25 of the 30 sent to the professional players were completed and returned. Both the professional rugby players and parents felt that mouthguards were essential when playing rugby. The professionals seemed to have a much greater understanding of the benefits that mouthguards provided. Although parents agreed that children should begin to wear mouthguards as soon as possible, very few actually did. The barriers to providing mouth protection were mainly financial combined with the difficulties of taking the child to the dentist. CONCLUSIONS: If the results from this small study are representative of the current situation, with regard to the wearing of mouthguards by professional players and children, it appears that there is a need for all those involved to ensure that rugby-playing children wear mouthguards. Rugby clubs could consider the appointment of honorary dental advisers and devise systems to ensure that cost is not a factor in preventing children from wearing mouthguards. Language: en

Osteonecrosis of the jaw after treatment with bisphosphonates is irreversible, so the focus must be on prevention.

Abstract: New generation bisphosphonates such as zolendronic acid, pamidronate, and alendronic acid have various indications in medicine. Initially, their use was restricted to patients with metastatic bone malignancy secondary to breast cancer, lung cancer, prostate cancer, or multiple myeloma. Their benefit in these conditions led to wider application for other bone pathologies, such as osteoporosis and Paget's disease.1 Their main effect is to inhibit osteoclast activity; however, they also seem to have antiangiogenic effects, …

Preformed metal crowns: views of a group of dental practitioners in North Wales.

Abstract: ObjectivesTo determine the views of general dental practitioners (GDPs) in North Wales on the use of preformed metal crowns (PMCs) for the treatment of primary molars.MethodFollowing ethical approv...

Primary double tooth: report of a rare correlation with the permanent dentition.

Abstract: Double tooth is a developmental anomaly that is seen more frequently in the primary than the permanent dentition. Double tooth involving primary canines and lateral incisors is found only in the mandible. The succeeding permanent lateral incisor is often found missing congenitally in the same region. This article reports a rare case of a double tooth involving a mandibular primary canine and lateral incisor. Instead of agenesis, the double tooth has been succeeded by a permanent supernumerary tooth in the same region.

Removable prostheses revisited: challenges for primary dental care. I. Complete dentures.

Abstract: The provision of removable prostheses remains a significant aspect of primary dental care. In the recent past and in the near future, there have been and will be significant new influences on how r...

Removable prostheses revisited: challenges for primary dental care. 2. Partial dentures.

Abstract: This is the second in a series of three papers. Its topic, the provision of removable prostheses, remains a significant aspect of primary dental care. In the recent past and in the near future, there have been and will be significant influences on how removable prostheses are provided for patients in the United Kingdom (UK). In this paper, the trends in partial edentulousness in the UK will be summarised and the important changes that are likely to influence removable partial denture provision will be outlined. The paper will then provide an update of clinical procedures in the provision of removable partial dentures. A third paper will consider overdentures.

Reply letters following orthodontic consultations: an audit of Merseyside general dental practitioners' satisfaction.

Abstract: ObjectivesTo assess the opinions of general dental practitioners (GDPs) working within the National Health Service (NHS) in Merseyside regarding the length, format and appropriateness of consultant...

Change management in a group dental practice. A consideration of management issues that may arise in a larger dental practice.

Abstract: The drive for quality assurance in general dental practice has arisen as a response to changing standards and demands. Dentists need to develop skills in change management in this new culture of change. Groups of practitioners often encounter difficulties when managing change, yet it is essential that they lead the process. Such problems are common among groups of professionals. A wide range of topics is presented that may, from one point of view, represent challenging or problem areas (obstacles) for a group practice but may also, from a different point of view, provide a framework of opportunities for improvement, and facilitate the management processes within the practice and the management of change in particular (tools). The range of skills required to assist a professional group is such that individual dentists or advisers may not be able to achieve much on their own. The best way forward may be to interpret the problems as a professional training need and to organise training as a group. These issues will be considered under the following headings: partners and teams; introduction: the need for change management; the challenge for group practices; obstacles and tools; conclusion: the way forward--a case for training.

A longitudinal study into changing ethical attitudes of newly-qualified dentists in South-East England.

Abstract: OBJECTIVE To report the ethical stances taken by newly-qualified dental graduates working in the south-east of England and how these changed over their first two years in practice. METHODS A longitudinal self-completed questionnaire-based study using scenarios and closed questions was completed by an initial group of 135 vocational dental practitioners at the very beginning of their vocational training year, at the end of the year, and, finally, at the end of the subsequent year. Their answers were then analysed to see whether or not their views had changed during this period. RESULTS At the commencement of the study in 2003, 133 (99%) newly-qualified dental graduates completed the questionnaire and answered the closed questions. The following year, 129 (96%) completed these documents and in 2005, at the end of the study, this figure was 97 (72%). There was considerable variation in the attitudes taken by the responding dentists. Reported attitudes changed over the study period in seven of the nine scenarios. Responses to the scenarios used could be grouped into three categories: those in which there was no change; those in which the change happened following completion of vocational training; and those in which there was a continual change. Answers to the four closed questions indicated a growing negativity to practice within the National Health Service over the study period. CONCLUSIONS Dental educators need to be aware of the findings from this study. The importance of the ethical attitudes held and the reasons underpinning them should be explored if problems with delivery of care are to be avoided in the future.

Inequalities in the provision of NHS primary care dental services in Scotland in 2004.

Abstract: ObjectiveTo assess inequalities in the provision of National Health Service (NHS) primary care dental services between Health Boards and the four provider groups (General Dental Service [GDS] non-s...

Pharmaceutical prescribing for children. Part 6. The management of medical emergencies in children in dental practice.

Abstract: This paper is the seventh in the series on prescribing medicines for child dental patients. Here, the authors aim to describe the medical emergencies that may occur in children presenting for denta...

vCJD and dental treatment: where are we now?

Abstract: Officer (CDO) for England recommended that endodontic files and reamers should be treated as single-use.1 This advice is based on the 2006 position statement from the Spongiform Encephalopathy Advisory Committee (SEAC) and early findings from an ongoing Health Protection Agency (HPA) study that highlight a potential risk of transmission of variant CreutzfeldtJakob disease (vCJD) during endodontic treatment. The CDO’s letter to dentists also reiterated previous Department of Health for England’s advice on the reduction of risk of transmission of vCJD, centring on the importance of presterilisation cleaning of instruments and the use of disposable alternatives where decontamination is difficult to achieve.

Opportunities for prevention: more than 'just the mouth'.

Abstract: This paper has been written by two dentists from Colombia who are currently waiting to take the International Qualifying Examination. They have been working as dental nurses in London and have gained insights into both NHS and non-NHS practice in London. They have a particular interest in preventive dentistry and have analysed recent developments in England with regard to the prevention of disease and oral disease in primary care. They propose a preventive approach which brings together recent policy developments in the United Kingdom and worldwide. They conclude that there are now potentially better opportunities than ever before to develop programmes to promote health and prevent oral disease, and to adopt a team approach to achieve these goals.