Biomedical subjects

A C Mellor

Publications and source records attributed to A C Mellor.

At least 19 recordsLinked to original sources

PubMed2006

The effect of pre-soaking and time in the ultrasonic cleaner on the cleanliness of sterilized endodontic files.

AIMS: To assess whether pre-soaking files in an enzymatic cleaner prior to ultrasonic cleaning had any effect on cleanliness and also to assess the effect of the time that endodontic files spend in an ultrasonic bath prior to sterilization on their overall cleanliness. METHODOLOGY: Twenty root canals in a total of ten patients were cleaned and shaped using conventional techniques. Following use, some of the files were pre-soaked and then ultrasonically cleaned for either 5, 10, 30 or 60 min. Other files had no pre-soaking and were then ultrasonically cleaned. There were two control groups, one where the files were pre-soaked and not ultrasonically cleaned and the other where the files were neither pre-soaked nor ultrasonically cleaned. All files were then subjected to a standard packing and autoclaving process. Following autoclaving, the files were examined using a light microscope at a magnification of 40x. The cutting section of each file was divided into two parts, the tip and the shaft, for visualization under the microscope. Any debris or cement on the files was scored using a modification of the scale used by Smith et al. (Journal of Hospital Infection, 51, 2002, 233). The data were analysed using one-way analysis of variance. RESULTS: Pre-soaking had no significant effect on the cleanliness of the files (P = 0.18 at the tip, P = 0.93 at the shaft). Ultrasonic cleaning had a significant effect on the cleanliness of the files (P < 0.00) but there was not a linear relationship between cleanliness and the ultrasonic cleaning time. There was little benefit in extending the ultrasonic cleaning time beyond 5 min. Calcium hydroxide deposits on two files were resistant to ultrasonic cleaning. CONCLUSIONS: There is no benefit in pre-soaking endodontic files prior to ultrasonic cleaning. The optimum time for ultrasonic cleaning was between 5 and 10 min. Further ultrasonic exposure, up to 60 min, did not improve cleanliness. Although a majority of files were free from debris following ultrasonic cleaning, a substantial minority still retained debris. This supports the case for endodontic files being single-use only.

Calcium Hydroxide↗

PubMed2005

The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis.

AIM: To examine whether an intra-oral injection of a nonsteroidal anti-inflammatory drug (ketorolac), in association with conventional local anaesthetic techniques, would improve the pulp extirpation rate in teeth with irreversible pulpitis. METHODOLOGY: A two group double-blind clinical trial was undertaken in the Dental Casualty Department of the University of Manchester School of Dentistry. Patients were randomly allocated to either the test or control group. The test group received an intra-oral injection of ketorolac (30 mg in 1 mL) in the buccal sulcus adjacent to the tooth being treated. After an interval of 15 min, they then received 2.2 mL of 2% lidocaine with 1 : 80 000 epinephrine by buccal infiltration in the maxilla or by inferior dental block in the mandible. The control group received an intra-oral injection of normal saline (1 mL) in the buccal sulcus adjacent to the tooth being treated, followed by the same local anaesthetic regime as the test group after the 15 min interval. Fifteen minutes after the local anaesthetic injections, pulp extirpation was attempted. All patients completed the short-form McGill pain questionnaire prior to treatment and completed identical questionnaires at 6 and 24 h after treatment. RESULTS: The study protocol set the number of patients to be treated at twenty. However, as the study progressed it became apparent that the intra-oral injection of ketorolac caused significant pain to four of the five patients who received it; therefore the study was terminated after ten patients had been treated. The results from the patients treated showed no significant difference in the pulp extirpation rate between the test and control groups. However, patients with higher pain scores at baseline were less likely to have the pulp completely extirpated, irrespective of whether they were in the test or control group. Pain scores for all patients decreased significantly from baseline to 24 h. CONCLUSION: An intra-oral injection of ketorolac did not improve the pulp extirpation rate in a small group of patients with irreversible pulpitis compared with a placebo. In addition, it was associated with such significant pain on injection that it cannot be recommended as a treatment in this situation.

Adult↗

PubMed2004

Factors affecting fee setting for private treatment in general dental practice.

OBJECTIVES: To examine how pricing policies were contrived in general dental practice in terms of fee-for-item and hourly rate and how these were affected by specialist status and the level of private care provided in a practice. DESIGN: A postal questionnaire. SUBJECTS: Members of the British Society for General Dental Surgery working in dental practice. RESULTS: Out of 160 eligible members, responses were received from 124 members (78%). Fifty-seven respondents claimed to specialise in one or more fields of dentistry. The majority of respondents consulted fellow colleagues or partners for advice on fee setting. A minority took external advice. The charging method varied according to the item of treatment with fee-for-item used predominantly for items such as a new patient examination, and hourly rate used more for items such as a direct composite restoration. Seventy-one respondents stated that their practice was 80-100% private treatment and these practitioners were significantly more likely to charge by hourly rate than fee-for-item for many items of treatment. Specialist status did not have any effect on charging method. The most important factors related to the setting of fees-for-item or hourly rate were clinical time spent, practice overheads and laboratory costs. CONCLUSIONS: This project has taken the views of a large group of experienced general dental practitioners, many of whom work purely in the private sector. The most important factors affecting fee setting were clinical time, practice overheads and laboratory costs. The method of charging was most affected by the proportion of private treatment provided by the practice.

Dental Care↗

PubMed2004

The incidence of occupational exposures among students in four UK dental schools.

OBJECTIVES: To evaluate: the incidence of occupational exposures (OE) to patient body fluids among a sub-group of dental students; the rate of reporting of incidents; and the association of various factors. DESIGN: Multicentre retrospective analysis. SETTING: Four UK dental schools in 2000. SUBJECTS: Dental students from 4 UK schools completed a confidential questionnaire at the end of the clinical years of their undergraduate course. RESULTS: The response rates ranged from 71-100%, showing that 12-40% of students among the schools had experienced one or more OE incidents since starting their course. No statistically significant association was found between OE incidence and age, sex, dominant hand or time of day; most OE occurred with handling of local anaesthetic syringes. 61-78% of incidents were penetrative in nature, and 28-53% of students had not reported their last OE. OE incidence was associated with school, year of course, presence of patient and presence of an assistant. There were substantial differences in the numbers of students experiencing OE among the schools. CONCLUSIONS: Within the limitations of the survey and variations within the clinical activity of schools, it may be seen that improvements are needed in some schools to reduce cross-infection risks, and increase reporting of incidents. Suggestions are offered which may increase the safety of dental treatment.

Anesthetics, Local↗

PubMed2001

The sealant restoration: indications, success and clinical technique.

In this paper we have considered the available literature which demonstrates that sealant restorations perform at least as well as amalgam restorations and are more conservative. Success depends on retention of the overlying sealant and if this is fully retained it is unlikely that any residual caries will progress. The diagnosis of occlusal caries and indications for sealant restorations are discussed and the clinical technique is described. We have concluded that sealant restorations are the optimum restoration in small and discrete occlusal cavities.

Composite Resins↗

PubMed2001

An investigation into sealant restoration usage in general dental practice in England.

AIM: A study was undertaken to investigate attitudes to sealant restorations and their usage in general dental practice in England. METHOD: Seventy three dentists in three areas (Doncaster, Hereford/Worcester and Wycombe) provided retrospective details of treatment provided over a one year period for 4,250 6-12 and 13-15 year old subjects. Fifty nine of these dentists then completed a telephone questionnaire relating to their treatment patterns and attitudes to sealant restorations. RESULTS: The treatment data indicated that only 59 of the 4,250 children received a sealant restoration during the study period. Of the 44 dentists who claimed in the questionnaire to be using sealant restorations, only 28 had placed them in their selected patients. CONCLUSIONS: Positive attitudes to sealant restorations were expressed but also concerns that may be prejudicing usage.

Adolescent↗

PubMed2001

Management information failings and future requirements for dental commissioning groups.

OBJECTIVE: To examine existing secondary care management information systems for dental specialities, and to determine their completeness and suitability for supporting effective primary care led purchasing decisions. DESIGN: An observational cross-sectional study of current information systems in selected secondary care provider units and the applicability of their data for contracting dental services. A comparative study of two information systems in two settings (primary and secondary care) and the utility of the data gathered for contracting for dental services. SUBJECTS: Secondary care activity data was sought from the key secondary dental care providers (hospitals) in two dental total purchasing localities. Referral data were also collected directly from general dental practitioners. MAIN OUTCOME MEASURES: The integrity, quality and accuracy of current secondary care activity data in dental specialities, in comparison to data supplied from primary dental care. RESULTS: The secondary care activity data was found to be incomplete, inadequate and inaccurate. It was found that due to data retrieval insufficiency, indicative budgets for secondary providers may be reduced to less than half of their actual entitlement. The data inflated individual dental outpatient attendance by 3.3 times between 1995/6 and by 2.5 times between 1996/7. CONCLUSION: Existing management information systems within secondary care providers are not structured in a way which will adequately inform future commissioning by the dental profession. Communication between primary and secondary care must be increased and data inputting methods in secondary care provider units must be substantially improved.

Budgets↗

PubMed2001

Treatment planning for the problem patient: restorative, ethical, legal and psychological perspectives. Case I: Emma.

'Emma' is the first of a series of four articles that aims to look at some of the problems patients may present with when they visit their dentist. Each article starts with a brief scenario about the hypothetical patient and his/her clinical problems. As well as the clinical problem, each case also raises ethical, legal or psychological problems. All of these issues are discussed and possible management strategies and treatment options described.

Adolescent↗

PubMed2001

Treatment planning for the problem patient: restorative, ethical, legal and psychological perspectives. Case 3: Mary.

Mary' is the third of a series of four articles that aims to look at some of the problems patients may present with when they visit their dentist. Each article starts with a brief scenario about the hypothetical patient and his/her clinical problems. As well as the clinical problem, each case also raises ethical, legal or psychological problems. All of these issues are discussed and possible management strategies and treatment options investigated.

Adult↗

PubMed2001

Treatment planning for the problem patient: restorative, ethical, legal and psychological perspectives. Case 4: Mr Lester.

'Mr Lester' is the final case study in a series of four articles that aims to look at some of the problems patients may present with when they visit their dentist. Each article starts with a brief scenario about the hypothetical patient and his/her clinical problems. As well as the clinical problem, each case also raises ethical, legal or psychological problems. All of these issues are discussed and possible management strategies and treatment options investigated.

Aged↗

PubMed2000

The ability to successfully include primary dental care practitioners in commissioning groups.

OBJECTIVES: To evaluate two total purchasing (TP) sites and ascertain whether general dental practitioners (GDPs) could be successfully included in the total purchasing model of health care commissioning. Another objective was to examine the role GDPs may play in future primary care commissioning groups and trusts. DESIGN: An observational cross-sectional study of two dental purchasing pilots in the North West Region. SUBJECTS: Two TP sites were studied, one in South Cheshire, the other East Lancashire. Each TP organisation had a dental subgroup which had a formal structure and was given an active role in dental healthcare service decision making. MAIN OUTCOME MEASURES: General dental practitioners' ability to manage dental health care provision in the selected sites and the suitability and effectiveness of the services managed by them. RESULTS: GDPs were willing and able to form cohesive primary care commissioning organisations but attitudes in secondary care prevented the implementation of their decisions. CONCLUSIONS: Structural, organisational and psychological changes would be necessary if GDP led purchasing were to be successfully implemented. Such changes are vital if GDPs and the dental profession are to have an effective role in the newly formed primary care groups and trusts.

Community-Institutional Relations↗

PubMed2000

Past and present attempts to control health service expenditure and its effects on National Health dentistry.

OBJECTIVE: To examine the methods used by policy makers to try to reduce or limit expenditure within the National Health Service. METHOD: A chronological examination of cost related health care policy and its wider impact on society. Comparison of past developments in the NHS with new methods of health care organisation in the United Kingdom (UK). The experiences of two dental Total Purchasing Pilots are used to describe where the dental profession now stands in relation to current NHS developments. RESULTS: The introduction of Primary Care Groups (PCGs) constitutes part of a continued effort by health care policy makers to control expenditure on health services. In the PCG system, as in Total Purchasing (TP), a group of primary care practitioners control a finite budget. These groups therefore must decide which health care services should be available to the population they represent. Inevitably such systems result in the rationing of health care, but the decisions are instigated by primary health care professionals rather than by government edict. CONCLUSION: Unless GDPs are allowed, willing and able, to participate in and influence the newly emerging Primary Care Groups and Trusts, dental services may once again be pushed to the fringe of NHS care provision. Without adequate representation, the value of dental care may not be recognised and PCGs may decide to make use of traditional dental resources, to fund other services.

Cost Control↗

PubMed2000

The use of hypnosis in dentistry: a review.

Hypnosis is a valuable technique in patient management. With appropriate training, general dental practitioners can widen the treatment options they can offer to patients, especially those who are dentally anxious. This article provides a brief theoretical and historical overview, and a review of the literature pertaining to the clinical uses of hypnosis in dentistry.

Analgesia↗

PubMed1999

Prevalence and attitudes to fissure sealants in the general dental service in England.

OBJECTIVES: The study objectives were to investigate changes in the prevalence of fissure sealants over a 5-year period among a comparable group of 14-15-year-old regular dental attenders registered with general dental practitioners in 1989 and 1994, and to investigate attitudes towards this form of care amongst general dental practitioners in 1994. METHODS: Random samples of 14-15-year-old pupils were selected from school lists in three areas in England (Doncaster, Hereford/Worcester and Wycombe) in 1989 and 1994. Once parental consent had been gained to examine the children, the Dental Practice Board (DPB) indicated which subjects were 'regular attenders', only these subjects were included in the study. All the subjects in each area were examined by a single trained and calibrated examiner using a standardized technique. In 1994, a group of randomly selected dentists in each area completed a telephone questionnaire assessing attitudes and treatment patterns regarding fissure sealants. RESULTS: In 1989, 2836 letters were posted to parents asking for consent to examine their child and 2174 positive responses were received (response rate 77%). Of the 1919 children examined, 459 were classed as regular attenders, 140 in Doncaster, 159 in Hereford/Worcester and 160 in Wycombe. In 1994, 2560 consent letters were distributed to children in school to pass to their parents and 1587 positive responses were received (response rate 62%). Of the 1388 children examined, 891 were classed as regular attenders, 294 in Doncaster, 318 in Hereford/Worcester and 279 in Wycombe. Large rises in sealant prevalence were observed in all areas, but particularly in Doncaster where sealant prevalence increased from 13% in 1989 to 50% in 1994. In Hereford/Worcester it increased from 25% to 47% and in Wycombe it increased from 16% to 30%. There was also a fall in mean DMFT in all areas. In Doncaster it fell from 2.97 in 1989 to 1.82 in 1994, in Hereford/Worcester it fell from 2.60 to 1.83 and in Wycombe it fell from 1.86 to 1.29. In all three areas the changes in sealant prevalence and DMFT were statistically significant. The questionnaire revealed positive attitudes towards fissure sealants and their usage as well as a number of areas of concern that could potentially hinder sealant usage. CONCLUSIONS: Dramatic increases in sealant prevalence and considerable reductions in dental caries among these regularly attending adolescents have been demonstrated. Some concerns were highlighted regarding sealant usage, which may be prejudicing further increases in their application.

Adolescent↗

PubMed1999

Treatment of dental fears: pharmacology or psychology?

Fear of dental treatment constitutes one of the major obstacles to receiving dental treatment, in both the UK and the USA. Treatment for such fear can be pharmacological or psychological, or a combination of both. In this article the aetiology, diagnosis and treatment of dental fear will be described and the treatment methods compared.

Adult↗

PubMed1999

A survey of patient perceptions of dental charges.

The aim of this study was to examine patients' perceptions of charges for dental treatment. A sample of 96 patients attending the University Dental Hospital of Manchester completed two short questionnaires on the monetary value of various dental treatments (a dental examination, a scaling, an amalgam restoration, a crown, an extraction, a denture, a root filling and a radiograph). The first questionnaire gave no details of the procedures and also asked patients which of the items of treatment they had experienced. The second questionnaire asked about the monetary value of the same items but gave the patients a short description of what the procedure entailed. The mean values for all the items of treatment were significantly higher in the second questionnaire than in the first. Patients who had a crown placed a significantly higher value on this treatment than patients who did not have a crown. The implications for pricing strategies in general dental practice are discussed.

Adult↗

PubMed1997

An assessment of capitation in the General Dental Service contract 2. Patterns of treatment provided to regularly attending patients.

OBJECTIVE: To compare the patterns of treatment of general dental practitioners working under fee-for-service in 1987/88 with those working under capitation in 1992/93. DESIGN: 73 randomly selected general dental practitioners working under capitation in three contrasting areas in England retrospectively recorded the treatment provided during 1992/93 to a random selection of their regularly attending 6-12- and 14-15-year-old patients. RESULTS: Mean numbers of examinations per year reduced in the three areas from 1.7-1.8 in 1987/88 to 1.2-1.4 in 1992/93. Mean numbers of visits per patient dropped from 2.5-2.9 to 1.8-2.2. Mean numbers of fillings in permanent teeth reduced from 0.15-1.04 to 0.09-0.52 and in deciduous teeth from 0.28-0.53 to 0.24-0.31. Mean percentages of children per dentist having extractions fell from 9.3-28.1% to 4.7-16.2% while the radiographs reduced from 14.0-9.0% to 6.0-10.6%. Mean percentages of children per dentist receiving oral hygiene instruction rose from 18-31% in 1987/88 to 26-33% in 1992/93. Dietary advice increased from 3-18% to 11-20% and fissure sealants from 3-6% to 3-12%. CONCLUSIONS: In 1992/93, dentists working under capitation were carrying out fewer examinations, fillings and extractions and were taking fewer radiographs for their regularly attending child and adolescent patients than dentists working under fee-for-service in 1987/88. These patients also attended less frequently for treatment but received marginally more preventive care and advice.

Adolescent↗

PubMed1997

An assessment of capitation in the General Dental Service Contract. 1. The level of caries and its treatment in regularly attending children and adolescents.

OBJECTIVE: To assess the dental health of regularly attending 7-8- and 14-15-year-olds registered under capitation in 1994. To compare the dental health of regularly attending 14-15-year-olds registered under capitation in 1994 with regularly attending patients of a similar age treated under fee-for-service in 1989. DESIGN: Random samples of 7-8- and 14-15-year-olds. Data were recorded on decayed and filled teeth, extracted for caries and teeth fissure sealed. RESULTS: Prevalence of caries in first permanent molars of 7-8-year-olds was 15-16%. Mean caries experience of deciduous posterior teeth was 1.78-2.51. 83-86% had no more than two untreated, decayed, posterior deciduous teeth. Prevalence of caries in 14-15-year-olds was 44-60% while mean caries experience was 1.29-1.83. Reductions in caries experience of 30-39% in 14-15-year-olds for 1989-1994 were due mainly to falls of 42-45% in mean numbers of teeth filled. Increases in mean numbers of decayed, untreated teeth were 0.07-0.11. The proportion of patients with teeth extracted because of caries was 2.4-3.8%. 30-50% had fissure sealants in 1994 compared with 13-25% in 1989. CONCLUSIONS: Dental health of regularly attending capitation patients is generally satisfactory with little evidence of 'supervised neglect'. Prevalence of fissure sealants has increased while the numbers of filled teeth has reduced. Numbers of decayed, untreated teeth have increased but the numbers of teeth extracted for caries have remained low.

Adolescent↗