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PubMed1996

Survey of reasons for extraction of permanent teeth in Italy.

The purpose of the study is to collect information on the reasons given by dentists, randomly selected from the Italian Dental and Maxillo-Facial Association's, for extracting permanent teeth in Italy. From the 164 dentists responding, 1056 teeth in 839 patients were extracted during two weeks of working activity. More than two-thirds of the teeth were extracted for dental caries (34.4%) and periodontal disease (33.1%). The mean number of teeth extracted per patient showed a significant increasing trend with increasing age, being 1.09 in those from 16 to 39 yr, 1.25 in the 40-59-yr-old group, to 1.54 in those over 59 yr of age (F = 21.44; P < 0.0001). The third molar was the most frequently extracted tooth and 41.3% were removed due to impaction reasons, in particular from the mandible. The first and second molars and the premolars were extracted most often because of caries; more than half of the incisors and the canines were extracted for periodontal reasons; the majority of the teeth removed for prosthetic reasons, 57.1%, were incisors and canines, especially in the mandible; of the teeth extracted for orthodontic reasons, 47.4% were first and second premolars. The prevalence of subjects with at least one tooth extracted for dental caries and for orthodontic reasons were respectively significantly higher in the irregular than the regular attenders (chi-square = 46.55; P < 0.0001), and in the regular than the irregular dental attenders (chi-square = 63.12; P < 0.0001). Dental practitioners should promote targeted initiatives for prevention and treatment of diseases in order to reduce in particular the incidence of tooth extraction because of caries and periodontal disease.

Adolescent↗
PubMed2005

Contemporary dental practice in the UK: indirect restorations and fixed prosthodontics.

OBJECTIVES: To investigate, by questionnaire, the use and selection of materials and techniques for indirect restorations and fixed prosthodontics by dental practitioners in the North West of England and Scotland. METHODS: A questionnaire was sent to 1,000 general dental practitioners selected at random from dentists in Scotland and the North West of England. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed. RESULTS: A total of 701 usable questionnaires were returned, giving a response rate of 70%. When selecting a material for the core build-up of vital teeth, practitioners used the following materials (%): amalgam (60), dual and light-cured resin composite (54), glass-ionomer cements (47), compomer (29) and resin-modified glass-ionomer cements (24). Where the use of a post was indicated indirect posts of both precious (67) and non-precious (37) alloys were preferred to prefabricated posts by the majority of practitioners for the restoration of root filled teeth. Direct titanium (14) and stainless steel (14) posts were not used extensively. Impression materials used by the practitioners were as follows: addition-cured silicone (70), condensation-cured silicone (20), polyether (9) and polysulphide (2). Traditional glass-ionomer cements (59) were used for the luting of single and multiple porcelain fused to metal units, with zinc phosphate and polycarboxylate cements (33) being the preferred alternatives. CONCLUSIONS: The majority of the practitioners surveyed in this study used: amalgam for core build-ups; indirect posts; addition-cured silicone for impressions; and glass-ionomer cements for luting procedures.

Crowns↗
PubMed2002

A survey of endodontic practice amongst Flemish dentists.

AIM: The purpose of this study was to gather information on routine endodontic treatment performed by Flemish (Dutch-speaking Belgian) dentists. METHODOLOGY: A postal questionnaire was sent to all the 4545 Dutch-speaking dentists registered in Belgium. The questionnaire was made up of 38 questions with multiple-choice answers. Results from 32 questions are presented, covering subjects, such as demographic and professional activity, root-canal preparation and instrumentation, emergency procedures and postoperative complications, choice of irrigants and disinfectants, and choice of obturation techniques. RESULTS: A total of 1143 questionnaires (25.1%) were returned. Approximately 94% of the respondents were general practitioners. The results indicate that there are discrepancies between daily practice and academic teaching, especially regarding the use of rubber dam (only 3.4% report using it as a standard procedure) and the detection and preparation of a second mesiobuccal canal in maxillary first molars (70% never or seldom). Most GDPs reported that they completed treatment in two visits. The majority of practitioners used manual instruments manipulated with a filing technique; 38.9% of the respondents prepared root canals 1 mm short of the radiographic apex. The most popular emergency procedure for acute pain was pulpectomy (40.2%); 48% performed pulpectomy, prescribed analgesics and antibiotics for acute apical periodontitis. Approximately 35% reported complications after cases with chronic apical periodontitis were treated. The first-choice root-canal irrigant was sodium hypochlorite and approximately 65% used intracanal medication. The most popular obturation technique was cold lateral condensation (60%) with 29% using AH26 as a sealer. A high proportion of GDPs (80%) performed re-treatments. CONCLUSIONS: The results of this study confirm that many Flemish general practitioners are not following quality guidelines for endodontic treatment.

Acute Disease↗
PubMed2003

Endodontic treatment performed by Flemish dentists. Part 2. Canal filling and decision making for referrals and treatment of apical periodontitis.

AIM: To gather information on root-canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire reported in a previous study was also used to gather information on canal medicaments, canal filling, and in decision making for referrals and treatment of apical periodontitis. RESULTS: Calcium hydroxide as an interappointment dressing was used by 69.7% of the respondents. Approximately one-third of the respondents did not use any intracanal medicament. Caustic products used for pulp tissue fixation were used by 66.8% of the respondents. Cavit (48.2%) and glass-ionomer (31.3%) were the temporary coronal-filling materials used most often, followed by zinc oxide-eugenol and IRM(R). Cold lateral condensation of gutta-percha was the filling technique most used by the respondents (65.8%). Single-cone gutta-percha placement (16%), paste techniques (4.9%) and silver points (3.9%) were still used. Resin-based sealers were used most often (88.6%). Paraformaldehyde containing sealers such as Endomethasone and N2 were used infrequently. Approximately half of the practitioners were satisfied with their canal-filling technique, others felt that they could do better (43.0%); 0.7% were not satisfied. In cases with apical periodontitis, the size of periapical lesions and/or the presence of a root filling influenced the choice of endodontic treatment. The most common reasons for referral of endodontic cases were: retrieval of silver points, surgery, and post removal. CONCLUSIONS: The results of this study indicate that techniques and methods used for canal medication and canal filling were acceptable for the majority of the respondents. Re-treatment was underestimated as a treatment option.

Attitude of Health Personnel↗
PubMed2006

A review of dentists' use of digital radiography and caries diagnosis with digital systems.

OBJECTIVES: To investigate the evidence for (1) dentists' use of digital radiography and (2) the outcome of caries diagnosis with digital systems. METHODS: A literature search with the software search package PubMed was used to get internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. The search was limited to the years 1999-2005 since most papers dealing with the diagnostic value of digital radiography systems published before 1999 will hold little interest for today's users due to changes in the systems. The search strategies resulted in 123 articles (Table 1, #4 and #5). Original research articles (not reviews) were selected by the following inclusion criteria: (1) questionnaire studies on the use of direct digital intraoral radiography systems (not digitized film), (2) studies which used human teeth and natural caries lesions, and further in laboratory studies, the sectioned tooth was the gold standard for validating the presence or depth of a lesion. RESULTS: The search resulted in 42 articles fulfilling the above criteria, which could be grouped into three types of studies: (a) questionnaire studies, (b) clinical (in vivo) studies, and (c) laboratory (in vitro) studies. Nine questionnaire studies, five clinical studies and 28 laboratory studies were found. These studies and their results are summarized in Tables 2-5. CONCLUSIONS: The number of studies was limited, and some of the digital systems were evaluated in only one or two studies. A conclusive judgment may therefore not be possible for the majority of the digital systems selected for this review. There is a continuous need for the evaluation of new digital intraoral radiography systems that appear on the market, first and foremost for their image quality and diagnostic accuracy, but certainly also for their performance in the clinic, a clear deficiency observed after the literature search for the present review.

Dental Caries↗
PubMed2003

Clinicians' choices of restorative materials for children.

BACKGROUND: Recently, there has been an expansion in the range of tooth-coloured restorative materials available. In 1999, the National Health and Medical Research Council recommended clinicians use alternatives to amalgam in children 'where appropriate'. METHODS: A three-part 29-item questionnaire was developed, tested in a focus group, and distributed to members of the Australasian Academy of Paediatric Dentistry (AA; paediatric dentists and paediatric dentistry postgraduate students; n=55), and the Australian and New Zealand Society of Paediatric Dentistry, Victorian Branch (SPD; general dentists and dental therapists; n=50). Participant information, material choices, and six hypothetical clinical scenarios were addressed. RESULTS: The overall response rate was 74 per cent. For both groups, the first ranked factor influencing choice of restorative material for vital primary teeth was child age, and caries experience for vital first permanent molars. For moderate-sized Class I and II restorations in primary molars, a tooth-coloured material was chosen by 92 and 84 per cent respondents respectively. For restoring two separate proximal lesions in a primary molar, 65 per cent chose a tooth-coloured material followed by a stainless steel crown (27 per cent; all AA members), then amalgam (8 per cent). The SPD respondents were significantly more likely to choose glass ionomer cement for Class I and II restorations and for restoring two proximal lesions (all p=0.000) in primary molars than AA respondents, who were more likely to choose composite resins/compomers or amalgam/stainless steel crowns for these restorations. Younger respondents (21-40 years) were significantly more likely to choose composite resins/compomers or amalgam/stainless steel crowns (p=0.048) than older respondents (41-65 years), who were likely to choose glass ionomer cement. CONCLUSIONS: For Class I and II restorations in primary molars, glass ionomer cement was the material chosen most frequently (SPD respondents); preference for amalgam or stainless steel crowns was low (both SPD and AA groups). The wide range of materials chosen for the hypothetical clinical scenarios suggests the need for guidelines on selection of restorative materials, and the need for longitudinal studies to follow actual clinical outcomes of the materials chosen.

Adolescent↗
PubMed2006

Standard of care for the edentulous mandible: a systematic review.

STATEMENT OF PROBLEM: Implant therapies have increased the range of prosthodontic options for the treatment of edentulism. Considering both dentist- and patient-mediated outcomes, a universal treatment intervention for the treatment of the edentulous mandible has not been demonstrated. PURPOSE: The purpose of this study was to test the null hypothesis that there is no single standard of care for the edentulous mandible as defined by a specific treatment modality. MATERIAL AND METHODS: A review of the literature was undertaken seeking evidence of a superior intervention for the treatment of the edentulous mandible. A search of the English language peer-reviewed literature was completed using Medline and Google Scholar for the period from 1995 to 2005, focusing on evidence-based research. This was supplemented with a hand search of selected dental journals and textbooks. Longitudinal retrospective studies, longitudinal prospective studies, longitudinal experimental clinical studies, nonrandomized controlled studies, and randomized controlled clinical trials were included for review using a general linear hierarchical classification of studies. Articles that did not focus exclusively on treatment interventions for mandibular edentulism or on the effects of such therapies on the patient were excluded from further evaluation. The search period included articles that were published before the criteria for evidence-based literature were established, but this was not necessarily used to exclude an article. The last search was conducted on September 25, 2005. RESULTS: The literature demonstrates that the functional demands of edentulous patients are highly variable and that patient treatment responses are individual, vary significantly, and are influenced by psychosocial forces. The literature further demonstrates that patient acceptance of specific treatment modalities is modified by social and cultural influences, financial means, and adaptive capacity. Additionally, patient acceptance of a particular treatment modality is influenced by the educational background, knowledge, and experience of the dental health care provider, as well as by a host of other socioeconomic, regional, cultural, age, and gender influences. CONCLUSIONS: Within the limits of this review, there is no evidence for a single, universally superior treatment modality for the edentulous mandible. Better designed, long-term studies are required to further explore differences in patient acceptance to each treatment intervention for the edentulous mandible.

Clinical Trials as Topic↗
PubMed1997

Preventive technologies in dental practice in the UK.

Visits were made to 26 selected general dental practices in Greater Manchester, UK to record the preventive technologies used on 106 patients below the age of 18 years. In addition, the patterns of treatment of 72 general dental practitioners in three contrasting areas in England were recorded, 11 of whom used preventive dental units. No relationship could be found between the organisation of the practice and the amount or type of prevention supplied or the patterns of treatment provided. The value of the preventive technologies currently offered in general dental practice is questioned and further research is recommended to discover the best model of practice to achieve cost-effective prevention.

Adolescent↗
PubMed2006

Anterior crowns for primary anterior teeth: an evidence based assessment of the literature.

AIM: To review the literature concerning the restoration of primary anterior teeth with pre-formed crowns or with the use of crown forms. METHODS: A search of the dental literature was made electronically using key words: crowns, primary teeth, anterior teeth, strip crowns, stainless steel crowns, veneered crowns, (a)esthetic, restorative. All papers were reviewed and assessed for their relevance to paediatric dentistry and then graded according to a set or predetermined criteria. These criteria were used to identify those reports that met 100% of the criteria, graded A; 75% grade B1; more than 50% graded B2 and all others graded C. RESULTS: There were 90 papers in all using the key words. Of these none were rated grade A; B1 or B2 and all remaining valid papers (not single restoration case reports), 50 were graded C. Failure rates varied between 0% and 50% for strip crowns; 32-39% for veneered metal crowns. The review indicated there is some evidence as to the efficacy and value of using anterior primary teeth crowns because of the improved aesthetics that they achieve. There was an obvious lack of prospective well controlled studies and more studies are needed. CONCLUSION: No clinical studies concerning anterior crowns on primary teeth were identified that met all or even a majority of criteria, indicating that there was little, good scientific support for any of the techniques which clinicians have utilized for many years to restore primary anterior teeth. While a lack of strong clinical data does not preclude the use of these techniques it points out the strong need for well designed, prospective clinical studies to validate the use of these techniques.

Bibliometrics↗
PubMed2000

[The professional profile of the oromaxillofacial surgeon in the clinic].

The German Society of Oral and Maxillofacial Surgery (Die Deutsche Gesellschaft für Mund-, Kiefer- und Gesichtschirurgie) is celebrating its 50th birthday--an occasion to highlight the current professional and political situation and future perspectives in the clinics devoted to this specialty. To this end, structural data from 71 major clinics (or divisions) are analyzed. The clinics have 2,300 beds, 32 on average, with a variance width of 10:64. This corresponds to one clinic bed for approximately 35,000 inhabitants. The neighborhood of the clinics and thus the working conditions and personnel situation have changed markedly in the past few years. Working conditions are evident from the doctor-bed proportion with its resulting burden on the medical team. There are 244 assistants currently studying for their specialty; 107 others are striving for the additional title of "Plastic operations". Plans for positions are based less on the planned number of beds than on the number of cases, productivity, and treatment spectrum of the clinic, sometimes with a bonus for research and teaching. The outpatient sector, which plays a major role, is not considered. Health-care politics continue to stress budgeting and rationalization, i.e., further cuts for positions and beds, including for maxillofacial clinics. While the professional and political concerns of the clinic doctors increase, health insurances are increasingly exerting influence on medical services and the financing of hospitals. This can prove life threatening for the clinics. The administrative structure of the clinics is also being questioned and is to be replaced by a collegial system. But the survival of the clinics and their personnel structure depend specifically on qualified management, clearly set goals, the ability to integrate, and openness to innovation. The advanced education of young oral and maxillary facial surgeons should be reconsidered, and more unlimited positions for medical specialists should be created. If the high standard of our specialty and the quality of education can be strengthened and extended, the perspectives for the future of clinical oral and maxillofacial surgery can be considered to be propitious, in spite of aggravated conditions.

Dental Clinics↗
PubMed2005

Survey of the use of hyperbaric oxygen by maxillofacial oncologists in the UK.

Oral and maxillofacial surgeons often use hyperbaric oxygen (HBO). Our aim was to find out the referral pattern of these surgeons for HBO. We contacted oral and maxillofacial units in England, Wales, and Scotland and identified 125 consultants who are involved in the management of patients with cancers of the head and neck. We sent these surgeons a postal questionnaire and 91 (73%) replied. Eighty-five of these consultants (93%) saw patients with osteoradionecrosis and only five of these never referred patients for HBO. About half the respondents (57%) saw patients for the insertion of osseointegrated implants after radiotherapy to the jaw, and seven of these never referred patients for HBO. All the respondents saw patients who required mandibular molar extractions after radiotherapy and 30 (33%) never referred these patients for HBO. Most consultants were unaware of the method of delivery of HBO. This survey suggests that most surgeons consider HBO to be part of the management of osteoradionecrosis, but their knowledge about delivery is weak and protocols vary.

Attitude of Health Personnel↗
PubMed2006

Follow-up after treatment of squamous cell carcinoma of the oral cavity: current maxillofacial practice in the United Kingdom.

Although patients are commonly reviewed after primary treatment for squamous cell carcinoma (SCC) of the oral cavity, there is little evidence about the frequency and duration of such a review. To try and obtain further information about current practice within the United Kingdom we used a structured telephone questionnaire to contact 50 units. Most of them (n=40, 80%) had developed follow-up protocols, and 38 (76%) reviewed patients for 5 years. All units examined patients monthly for the first year, and 90% of patients were seen 2-monthly for the following year. Slight variations for follow-up existed in years 3 and 4, but by the fifth year, 6-monthly review was almost universal (96%). Despite this surprising concordance, few units implemented a risk-adapted follow-up protocol that was aimed at targeting those people likely to be cured of relapsing disease.

Carcinoma, Squamous Cell↗
PubMed2006

The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries.

OBJECTIVE: To assess the strength of the evidence describing the effectiveness of alternative strategies to the detection and management of early occlusal caries and suspected occlusal dentinal caries. METHODS: Nine detection and intervention decision points were identified as being central to the management of early occlusal caries and suspected occlusal dentinal caries, or suspicious areas. For each decision point, the evidence for effectiveness was assessed, using existing systematic reviews when available, and nonsystematic review methods when necessary. RESULTS: For the 2 detection decisions (early occlusal caries and suspicious areas) the strength of the evidence was weak. Accuracy in detecting early occlusal caries was extremely variable within and across detection methods. Approximately 50% of suspicious areas identified had dentinal caries. The strength of the evidence for effectiveness of nonsurgical approaches for the management of early occlusal caries was weak for all 3 management strategies examined (doing nothing, sealants, remineralization). This evidence suggested that sealants were highly effective, with remineralization reflecting moderate effectiveness. For the management of suspicious areas, the strength of the evidence was still weaker and reflected the same relative effectiveness. For the surgical management strategy for suspicious areas, operative treatment, the evidence was strong and reflected high effectiveness for preventive resin restorations, but no evidence was available for minimally invasive techniques. CONCLUSION: Identification methods for early occlusal caries are not accurate. The strength of the evidence for effectiveness of nonsurgical management strategies for early occlusal caries is at best, weak. The available evidence suggests that sealing both enamel caries and suspected occlusal dentinal caries is the most effective management approach if subsequent maintenance of the sealed surfaces can be assured.

Adolescent↗