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Biomedical subjects

P J Waterhouse

Publications and source records attributed to P J Waterhouse.

18 recordsLinked to original sources
PubMed2006

Is there life after Buckley's formocresol? Part II - Development of a protocol for the management of extensive caries in the primary molar.

OBJECTIVE: To produce a working clinical protocol for pulp therapy techniques in the extensively carious primary molar. INTRODUCTION: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. As such, a medicament that can be used to replace formocresol in clinical practice should be identified. METHODS: Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence-based protocol, for the management of the extensively carious primary molar. CONCLUSION: A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.

Algorithms↗
PubMed2006

Is there life after Buckley's Formocresol? Part I -- a narrative review of alternative interventions and materials.

OBJECTIVES: (1) To present a narrative review of the currently available alternative interventions and materials to formocresol pulpotomy for the management of extensive caries in the primary molar, and (2) to produce a clinical protocol for pulp therapy techniques in the extensively carious primary molar. INTRODUCTION: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. Since Buckley's Formocresol contains 19% formaldehyde in its full strength and, therefore, 1% in a 20% dilution, a safer alternative should be identified. METHODS: A narrative review of the published literature for primary molar pulp therapy techniques was undertaken following an extensive and appropriate literature search. A specialist group of paediatric dentists was formed to arrive at a consensus and establish an evidence-based protocol for the management of extensively carious primary molar teeth. Part I of this paper explores the currently available alternative interventions and materials to formocresol in the form of a narrative review. The second part of the paper will present the formation of a specialist group to arrive at a consensus and establish an evidence-based protocol for the management of the extensively carious primary molar. CONCLUSIONS: After consideration of a review of extensively searched literature, a protocol and key points document have been developed to assist clinicians in their treatment planning. Further long-term studies with the highest level of evidence (i.e. randomized controlled trials) are required to enable us to identify acceptable alternatives which can replace formocresol.

Aluminum Compounds↗
PubMed2006

Tutor perceptions of the use of a reflective portfolio within a pastoral tutor system to facilitate undergraduate personal development planning.

All Higher Education Institutions in the UK are now required to provide transcripts of student activity and outcomes of summative assessments. In addition, the student should be able to reflect on their learning and plan their own development. This article reports on the staff evaluation of the use of a reflective portfolio facilitating the production of highly individualised personal development plans within an existing tutor system. A number of significant issues are highlighted; tutor systems adopting this approach must maintain flexibility for managing student crises when they arise, the difference between appraisal and assessment needs clear definition for both students and tutors, training in basic mentoring skills should be provided for all tutors, tutors should be aware of the difficulties many students experience with reflection and also be alert to the over reflective learner.

Documentation↗
PubMed2006

Factors affecting treatment outcomes following complicated crown fractures managed in primary and secondary care.

The aims of this retrospective observational study were to determine the factors which affect treatment provision and the Median Survival Time (MST) for maintenance of tooth vitality following complicated crown fracture. The survey was carried out for patients treated at Newcastle Dental Hospital (NDH) according to departmental guidelines over a 2-year period following the introduction of a new protocol for management of these types of injuries. Seventy-three cases of complicated crown fracture were identified in 69 children with a mean age of 10.3 years (SD = 2.5 years). Seventy-one percent of the fractures occurred in males (M:F ratio was 2.5:1). Fifty-one percent of the complicated crown fractures were in immature teeth. Of the 73 traumatised teeth, 45% presented initially in general dental practice (GDP), 37% at the dental hospital and 8% at local accident and emergency departments with the remaining 10% seen at other or unrecorded locations. Of the 41 fractures, which presented initially at a location other than the dental hospital, 38% were referred to the dental hospital without the provision of an emergency pulp bandage. The overall definitive treatments provided for the 37 open apex teeth included pulp cap (19%), partial pulpotomy (32%), cervical pulpotomy (8%) and pulpectomy (35%), while for the 36 closed apex teeth it was pulp cap (28%), pulpotomy (11%), and pulpectomy (61%). Of the 30 teeth, which underwent vital pulp therapy (18 open and 12 closed apex), the MST for the 15 teeth treated with pulp caps was 1460 days (95% CI: 1067, 1853) while for the 15 teeth treated with pulpotomies it was 1375 days (95% CI: 964, 1786). There was no statistically significant difference in the MST between teeth treated with pulp caps and pulpotomies. In conclusion, the proportion of patients referred to secondary care with complicated crown fractures without provision of a pulp bandage is of some concern. More conservative treatment of closed apex teeth sustaining complicated crown fractures, utilizing vital pulp therapy techniques would appear to be appropriate.

Adolescent↗
PubMed2005

Management of dental trauma in primary care: a postal survey of general dental practitioners.

OBJECTIVES: To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. DESIGN AND SETTING: A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. MAIN OUTCOME MEASURES: Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. RESULTS: The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Eighty-eight per cent of GDPs felt that aids to management would be useful. CONCLUSIONS: Although GDPs believed that financial remuneration was inadequate, this did not prevent them treating trauma cases. They strongly agreed that they had responsibility for the management of dental trauma in primary care and that they believed trauma could be treated more effectively in practice if payment was greater. Time constraints were perceived as a barrier to long-term management of complex trauma cases in primary care. GDPs would welcome the use of management aids.

Analysis of Variance↗
PubMed2005

The dental attitudes, knowledge and health practices of patients with Juvenile Idiopathic Arthritis.

AIM: To investigate the dental attitudes, knowledge and dental health practices of children and adults with a previous diagnosis of Juvenile Idiopathic Arthritis (JIA). STUDY DESIGN: A self-completion questionnaire. METHODS: Ninety-one children and 82 adults with JIA were age and gender matched with 152 healthy controls. For those below the age of 16 years, the parents' attitude, knowledge and dental health practices were investigated by the questionnaire. The adult subjects and controls completed an identical questionnaire assessing their own attitude, knowledge and dental health practices. RESULTS: Response rates of 84% and 75% were achieved for the subject and controls respectively. Both groups responded similarly to questions assessing perception of different medical conditions. The majority of respondents thought leukaemia was a very serious condition. Twenty-seven percent of subjects and 34% of controls felt dental decay was "slightly or not serious". Ninety percent of subjects and 93% of controls knew having sweet snacks during the day would harm teeth, but fewer were sure that eating sweet foods at mealtimes only would help reduce decay. The majority of respondents (63% and 56% respectively) did not know whether children should receive fluoride tablets but the majority of subjects in both groups had attended a dentist within the last year. STATISTICS: Descriptive analyses and chi-squared analysis were undertaken. A p-value of < or =0.01 was taken as strong evidence of a difference between groups. CONCLUSION: The perception of health and illness by both groups was appropriate. The questions investigating dental knowledge revealed understanding of the basic messages of prevention of dental disease, but finer detail appeared less well understood. Responses concerning dental health confirmed positive attitudes towards good dental health habits. The benefits of brushing with fluoride toothpaste were known, and the majority toothbrushed daily and received dental care within the previous year.

Adolescent↗
PubMed2003

Dental erosion and soft drinks: a qualitative assessment of knowledge, attitude and behaviour using focus groups of schoolchildren. A preliminary study.

OBJECTIVES: This qualitative study was designed to record the perception by Newcastle children of the influences on their choice of drinks and their knowledge of the dental health problems caused by acidic drinks. METHODS: Four focus groups, each involving 8 Newcastle schoolchildren (4 boys and 4 girls) formed the basis of the study. Two age groups, 13-14-year-olds and 8-9-year-olds, and two socio-economic groups were investigated, using state schools in Newcastle upon Tyne. A moderator guided the children to discuss their choice of drink and its dental effects amongst themselves. RESULTS: In total, 32 children participated in the focus groups and the results suggested that 8-9-year-olds preferred still, fruit-flavoured drinks whilst 13-14-year-olds preferred carbonated drinks. Taste was the most important influence on drink choice in all age groups. Parents and friends were more influential in younger children, whilst cost, availability and thirst were more important to older children. Younger children did not believe advertisements whilst older children thought they might work if seen enough times. Dental knowledge was confused in all age groups and only the 13-14-year-old-high socio-economic groups knew that acidic drinks were bad for the teeth. Different methods for addressing the problem of erosion were suggested by different age groups. There was very little difference between the socio-economic groups in the areas discussed. CONCLUSIONS: The children's knowledge of dental diseases and the effect of drinks on the teeth were confused. The factors that influence drink choice appear to change with age, rather than socio-economic status.

Adolescent↗
PubMed2002

Prostaglandin E2 and treatment outcome in pulp therapy of primary molars with carious exposures.

OBJECTIVES: Prostaglandin E2 (PGE2) has been suggested as an indicator of irreversible pulpitis in permanent teeth [1]. There is scant information on the role of chemical mediators in primary molar pulp inflammation. The aim of this preliminary study was to investigate the levels of PGE2 in blood harvested from root pulp stumps following coronal pulp amputation in vital primary molar teeth with carious exposures. METHODS: Seventy-nine cariously exposed primary molars underwent treatment by one of two vital pulp therapy techniques. Blood was harvested from 38 teeth and volume and concentration of PGE2 ([PGE2]) determined [2]. Treatment outcome was assessed from both clinical and radiographic evidence. RESULTS: PGE2 was detected in all samples, with a wide concentration range (1-2641 ng/mL). The distribution was skewed, requiring log transformation. The difference in the mean (log) [PGE2] for radiological success (3.12, SD 1.60 and failure (4.62, SD 1.80) was significant, t = 2.05, P = 0.047. The difference in the mean (log) [PGE2] for clinical success (3.24, SD 1.65) and failure (5.44, SD 1.43 was near-significant, t = 1.84, P = 0.074. CONCLUSION: [PGE2] correlated positively with radiological outcome following vital pulp therapy.

Calcium Hydroxide↗
PubMed2000

An investigation of the relative efficacy of Buckley's Formocresol and calcium hydroxide in primary molar vital pulp therapy.

OBJECTIVE: To compare the clinical and radiological outcomes following two different, single visit vital pulp therapy techniques, in cariously exposed primary molar teeth. SETTING: A paediatric dental clinic within the Dental Hospital, Newcastle upon Tyne, UK. SUBJECTS: Fifty two child patients were sequentially enrolled in the clinical investigation, 26 males and 26 females with an age range of 3.3-12.5 years. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). The total number of teeth treated was 84. DESIGN: Recruitment was on the basis of strict inclusion criteria. Coronal pulp amputation was prescribed only in teeth with vital, cariously exposed pulp tissue. Treatment was undertaken between October 1994 and December 1996. All cases were reviewed using predefined clinical and radiological criteria. The statistical tests used were logistic regression of a triple nested data structure, chi-squared analysis of equality of treatment and probability of success with relation to subject age. RESULTS: Eighty-four cariously exposed primary molars required vital pulp therapy. Forty six (55%) teeth were included in the F group and 38 (45%) allocated to the C group. Five teeth were lost to follow-up, leaving 79 teeth: forty four (56%) in group F and 35 (44%) in group C. Eighty four percent (37/44) of teeth treated with formocresol and 77 percent (27/35) treated with calcium hydroxide were classed as clinically and radiographically successful at the cut-off date, December 1997, after a mean clinical review of 22.5 months (range 6.1-38.5 months) and a mean radiographic review of 18.9 months (range 1.3-36.9 months). CONCLUSION: This investigation confirms the clinical efficacy of a one-fifth dilution of Buckley's Formocresol as an agent in pulp treatment of cariously exposed, vital primary molar teeth. However, calcium hydroxide in its pure, powder form is a clinically acceptable alternative when combined with strict selection criteria for this method of restorative care. There was a statistically insignificant difference in successful clinical and radiological outcome between the two treatment groups. Success was unrelated to the duration of time taken to achieve haemostasis and the presence or absence of bleeding after placement of the medicament.

Calcium Hydroxide↗
PubMed2000

Primary molar pulp therapy--histological evaluation of failure.

OBJECTIVES: Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsuccessful pulp treatment by two vital pulpotomy methods. SUBJECTS AND METHODS: The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley's Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty-two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariously-exposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy-nine cariously-exposed primary molars required vital pulp therapy. Forty-four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation. RESULTS: Post-extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge). CONCLUSION: The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under-researched treatment modality.

Calcium Hydroxide↗
PubMed1999

Development of a method to detect and quantify prostaglandin E2 in pulpal blood from cariously exposed, vital primary molar teeth.

AIM: The aim of this in vitro study was to detect and quantify an established marker of inflammation, prostaglandin E2 (PGE2), in blood samples harvested from radicular pulp stumps after coronal pulp amputation. METHODOLOGY: Harvesting was achieved by a paper strip 'dip-stick' method and the volume of each sample estimated before storage at -80 degrees C. A competitive, plate-based enzyme immunoassay technique (EIA) was developed for detection and quantification of the inflammatory mediator assumed to be present in blood samples. Since this technique had not previously been used to assess pulp blood, steps in the development of harvesting, storage, extraction and validation of this sensitive assay are described. RESULTS: Thirty-nine single-blood samples were assayed and yielded detectable amounts of PGE2 ranging from 1.0 to 2641 ng mL-1. CONCLUSIONS: The results of this investigation indicate that the inflammatory mediator, PGE2 can be detected and quantified in small blood samples from pulp stumps. Further development may derive quantitative tests for determining the condition of pulp tissue in primary molar pulp treatment.

Child↗
PubMed1999

Autotransplantation as a treatment option after loss of a maxillary permanent incisor tooth. A case report.

A case is described of the management of a maxillary left permanent incisor, damaged by several traumatic injuries, in a 13-year-old girl. The traumatized incisor tooth required extraction and as part of an orthodontic treatment plan, a mandibular left second premolar was surgically transplanted to the prepared extraction socket at the maxillary anterior alveolus. After splinting, the transplanted tooth underwent endodontic treatment, because of pulpal necrosis. Orthodontic treatment commenced 3 months post-transplantation. Permanent root obturation was provided after orthodontic treatment and a porcelain veneer was placed to restore aesthetic appearance. The case emphasizes the importance of correct case selection, a multidisciplinary approach to treatment planning, and regular follow-up for transplanted teeth.

Adolescent↗
PubMed1996

Intracoronal bleaching of nonvital teeth in children and adolescents: interim results.

This study was undertaken to investigate the outcomes in 20 children and adolescents who had undergone an intracoronal nonvital bleaching technique. Twenty-one discolored central incisor teeth were treated by the walking bleaching method and reviewed at intervals for 18 months following completion of bleaching. All teeth bleached lightened to varying degrees, and 62% of patients expressed satisfaction with the result. When a porcelain shade guide was used as a reference before bleaching, the percentage of teeth deemed off the shade guide, gray or reddish gray, was 97%. Immediately postbleaching, the percentage had been reduced to 57%, and relatively more teeth were at the lighter end of the scale for each color band. At 18 months, three teeth (17%) had been veneered, and 33% of the remainder were found to be off the shade guide, gray or red-gray. Radiographically, 81% of teeth were classified as healthy at 18 months, with no evidence of cervical or progressive apical resorption.

Adolescent↗
PubMed1995

Gingival overgrowth in paediatric cardiac transplant patients: a study of 19 patients aged between 2 and 16 years.

It is well established that both cyclosporin and nifedipine are associated with gingival overgrowth. However, there is little information on the prevalence of this undesirable effect in paediatric patients. The present study investigated gingival overgrowth in 19 cardiac transplant patients aged 2 years 8 months to 16 years 3 months (1.5-8.5 years post-transplant) and related such changes to variables of daily cyclosporin dosage, trough blood cyclosporin concentration and daily nifedipine dosage. Ten patients showed clinically significant gingival overgrowth and nine relatively minor overgrowth; there was no significant difference between the two groups with respect to age, length of time post-transplant, cyclosporin dosage, whole blood concentration of cyclosporin or intake of nifedipine. The expression of gingival changes therefore did not relate to any drug variable in this group of subjects.

Adolescent↗
PubMed1995

Crown and root resorption of a maxillary permanent first molar by an impacted second premolar: a case report.

A case is described of resorption of the mesial aspect of a maxillary permanent first molar in a 13-year-old boy whose maxillary second premolar was impacted. The premolar was partially erupted in the line of the arch and radiography revealed a radiolucent area involving enamel, dentine and cementum on the mesial aspect of the first molar. The first molar was extracted and the premolar erupted normally. The case emphasizes the importance of early diagnosis of developmental abnormalities.

Bicuspid↗