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PubMed2002

Caries development in a young population managed by a restrictive attitude to radiography and operative intervention: II. A study at the surface level.

OBJECTIVES: To longitudinally assess the distribution of fillings and carious lesions in permanent posterior tooth surfaces, caries states fillings were made, and survival time of proximal lesions in different states in a young population managed by minimal operative treatment and a restrictive attitude to radiography. METHODS: Bitewing radiographs from age 6-20 in 285 patients were analysed. Proximal and occlusal surfaces were coded for caries depth and fillings. Start and end dates for different caries states in proximal surfaces were assigned and survival times in these states calculated by means of survival statistics. RESULTS: The frequency of carious/filled occlusal surfaces in the population increased from 6 to 19% and that of proximal surfaces from 1 to 26%. At age 19, 86% of the occlusal and 7% of the proximal surfaces affected by caries were filled. An overwhelming majority of unfilled carious proximal surfaces had enamel lesions only. Of all fillings, 81% were placed in surfaces with dentine lesions. The occlusal and proximal surfaces of the first molar and the distal surface of the second premolar accounted for most lesions and fillings among the 19-year-olds. The average survival time of lesions in the enamel was 8.0 years and in the outer half of the dentine 3.4 years when right-censored data were taken into account. CONCLUSION: In a young population exposed to optimal levels of fluoride with a caries preventive programme, a restrictive attitude towards operative treatment can be combined with longer average intervals between radiographic examinations than those prescribed by current guidelines.

Adolescent↗
PubMed2002

Caries development in a young population managed by a restrictive attitude to radiography and operative intervention: I. A study at the patient level.

OBJECTIVES: To assess, in a young population (age 6-19) managed by a restrictive attitude to radiography and operative intervention, prevalence of patients with posterior caries and/or fillings, probabilities of new proximal dentine lesions given different caries experience, correlation between radiographic intervals and caries experience, and prevalence of endodontic treatment. METHODS: Bitewing radiographs, taken between age 6 through 19 in 285 patients, were analysed in succession. Occlusal and proximal surfaces were coded for caries depth (0-4) and presence of fillings (5). Simple regression analysis was used to determine relations between radiographic intervals and caries experience. Significance testings of probability estimates were made with chi(2)- and t-tests, when applicable adjusted by the Bonferroni-Holm correction for mass-significance. RESULTS: The prevalence of patients with >/ or =1 fillings/dentine lesions in occlusal surfaces increased from 6-78% and in proximal ones from 1-38%. The probability of developing new proximal dentine lesions/fillings over different time periods was significantly lower among caries-free patients than among those with enamel or dentine lesions. There was a poor correlation between radiographic intervals (mean=16 months, range=6-33) and accumulated caries experience. Endodontic treatment had been made in a total of six teeth in six patients. CONCLUSIONS: A restrictive attitude both to the frequency with which radiographs are taken and to operative treatment of proximal caries seems to be possible in young populations with low caries prevalence.

Adolescent↗
PubMed1998

Consistency of patient classification in orthodontic diagnosis and treatment planning.

The purpose of this study was to examine diagnosis and treatment planning categorizations used by experienced orthodontists. Thirty-nine clinicians were asked to evaluate six test cases and formulate a diagnosis and treatment plan for each. The information provided was categorized using a problem-oriented classification. The results indicate little agreement exists in diagnostic subcategories, such as molar relationship, degree of crowding, or the nature of skeletal discrepancies. There was also little agreement regarding some treatment strategies, such as extraction of teeth, the use of orthopedic appliances, or the use of surgery. A need exists for better definitions of diagnostic criteria and appropriate treatment options.

Decision Making↗
PubMed2000

Endodontic retreatment decisions: no consensus.

AIM: The objectives of the present study were to: (i) evaluate the consensus, if any, amongst dental schools, students and their instructors managing the same clinical cases, all of which involved endodontically treated teeth; and (ii) determine the predominant proposed treatment option. METHODOLOGY: Final year students, endodontic staff members and instructors of 10 European dental schools were surveyed as decision makers. Fourteen different radiographic cases of root canal treated teeth accompanied by a short clinical history were presented to them in a uniform format. For each case the decision makers were requested to: (i) choose only one out of nine treatment alternatives proposed, from 'no treatment' to 'extraction' via 'retreatment' and 'surgery' (ii) assess on two 5-point scales: the difficulty of making a decision, and the technical complexity of the retreatment procedure. RESULTS: The results indicate wide inter- and also intra-school disagreements in the clinical management of root canal treated teeth. Analysis of variance showed that the main source of variation was the 'school effect', explaining 1.8% (NS) to 18.6% (P < 0.0001) of the treatment variations. No other factor explained as much variance. Decision difficulty was moderately correlated to technical complexity (Pearsons' r ranging from 0.19 to 0.35, P < 0.0001). CONCLUSIONS: No clear consensus occurred amongst and within dental schools concerning the clinical management of the 14 cases. The lack of consensus amongst schools seems to be due mainly to chance or uncertainty, but can be partly explained by the 'school effect'.

Analysis of Variance↗
PubMed2000

Root canal treatment in general practice in Sudan.

AIM: The aim of this study was to evaluate the practice and depth of knowledge of root canal treatment by dental practitioners in Khartoum, the capital city of Sudan, in order to improve the current status of endodontic therapy. METHODOLOGY: A questionnaire was posted to 55 registered dental practitioners. Completed questionnaires were analysed in term of simple summary statistics. RESULTS: A total of fifty-two (95%) practitioners responded. Eighty-five per cent of the respondents indicated that they performed root canal treatment for their patients. Of these, 84% included molars in their activity. Amongst those who carried out root canal treatment, only one practitioner used rubber dam for isolation, whilst the remainder used cotton wool rolls. The majority of respondents (80%) used hydrogen peroxide to irrigate canals during treatment. Three-quarters of practitioners used formocresol as an inter-appointment medicament. The stepback preparation technique was the method of choice for 98% of respondents. All practitioners used hand instruments to prepare root canals and all used gutta-percha for obturation; three-quarters of them used cold lateral condensation for all or some cases. The average number of radiographs routinely taken for root canal treatment was three. Only 73% used radiographs for measuring the working length. Ninety-five per cent of respondents indicated that they usually completed a root filling in three or more visits. Three-quarters of practitioners restored the teeth permanently immediately after the obturation and one-quarter preferred waiting for 1 or 2 weeks. CONCLUSIONS: In Sudan, there are no dental practices limited to endodontics and no postgraduate training programmes. This survey shows the importance of establishing higher specialist training or continuing dental education for practitioners to update their knowledge.

Clinical Competence↗
PubMed2001

Paediatric antibiotic prescribing by general dental practitioners in England.

OBJECTIVES: The inappropriate use of antibiotics is known to be a major contributory factor to the problem of antimicrobial resistance. No information is available on how practitioners prescribe antibiotics for children. This study investigated the prescribing of liquid-based antibiotics for children by general dental practitioners in England. DESIGN: Analysis of National Health Service liquid-based prescriptions issued by general dental practitioners in England. SAMPLE AND METHODS: All prescriptions issued by practitioners in 10 Health Authorities in England for February 1999 were collected. All the liquid-based antibiotic prescriptions for children were selected and we investigated the type of antibiotic prescribed, whether sugar free, the dose, frequency and duration. RESULTS: A total of 18,614 prescriptions were issued for antibiotics. Of the 1609 liquid-based paediatric prescriptions 88.3% were for generic and 11.7% for proprietary antibiotics, of which 75.5% were for amoxicillin, 15.2% for phenoxymethylpenicillin, 6.6% for erythromycin, 1.7% for metronidazole. Cephalexin, ampicillin, cephadrine and combinations of two antibiotics were also prescribed. There was a wide variation in dosages for all the antibiotics prescribed. A significant proportion of practitioners prescribed at frequencies inconsistent with manufacturers' recommendations and for prolonged periods, with some practitioners prescribing for periods up to 10 days. Only 29.1% of all the prescriptions issued were sugar free. CONCLUSIONS: The results of this study show that some practitioners prescribe liquid-based antibiotics inappropriately for children. This may contribute to the problem of antimicrobial resistance. Clear guidelines on the choice of antibiotic, dose, frequency and duration along with educational initiatives for GDPs might reverse this trend.

Anti-Bacterial Agents↗
PubMed2003

Pain relief for paediatric dental chair anaesthesia: current practice in a community dental clinic.

AIM: A review of different modes of pain relief for simple dental extractions under general anaesthesia in a community dental setting. PATIENTS AND METHODS: Different analgesia regimens are used by different anaesthetic teams working in a single community clinic. A total of 72 patients were reviewed post-operatively in the recovery room and followed up with a telephone survey 24 h later to assess pain experienced by the patients. The efficacy of different analgesia regimens was analysed. RESULTS: The majority of patients were pain free in recovery, independent of the method of pain relief used. Local anaesthetic injections appear superior to systemic analgesia, and patients with local anaesthetic injections were more settled in recovery. DISCUSSION: Simple dental extractions cause pain and efficient administration of appropriate analgesia should be an integral part of the community dental service.

Adolescent↗
PubMed1997

Comparison between the sequential and simultaneous approaches for the restoration of adjacent proximal cavities.

The clinical situation in which several proximal carious lesions have to be treated is frequently encountered. The need to provide a cost-effective and time-effective treatment often compels the clinician to perform multiple adjacent proximal restorations simultaneously, at the same treatment session. Alternatively, such treatments may be performed sequentially in successive sessions. The different possible treatment modalities and their clinical sequel are described. Examination of the clinical results suggests that the preferred restorative procedure is the sequential one, enabling an optimal restoration of the original anatomical form, which is important for the proper health and function of the teeth and the surrounding periodontal tissues.

Dental Restoration, Permanent↗
PubMed1999

Continuing education courses in dentistry: assessing impact on practice.

INTRODUCTION: In the context of movement towards mandatory continuing dental education, this paper describes how a delayed postal questionnaire can be used in course evaluation. Specifically, the value of the questionnaire as a tool for assessing the impact of short course attendance on general dental practice is examined. METHOD: Questionnaires were distributed to all those attending three courses, ranging in size, in the West Midlands region. As well as reflecting on the course, respondents were asked their views on the usefulness of the questionnaire, the length of time between course attendance and assessment of impact, and types of courses likely to have greatest impact. RESULTS: Respondents thought the questionnaire an appropriate tool for assessing impact on practice, that an appropriate interval of time between the course and the delayed questionnaire is about six weeks, and that courses most likely to impact on practice are those which offer updates on common clinical topics and are hands-on in nature. DISCUSSION: A delayed questionnaire could be a useful mechanism for evaluating the impact on practice of some types of courses. Response rates from those attending large lecture courses might be low. Course evaluation is also limited by resources and time. Criteria for identifying which courses should be subject to such evaluation might include high cost per participant and links with review cycles. CONCLUSION: There is scope for more structured evaluation of continuing dental education, including the assessment of impact on practice. The questionnaire described is a useful component of an evaluation framework.

Attitude of Health Personnel↗
PubMed2004

[Tooth transposition: results of an enquiry among practitioners].

A questionnaire was sent to orthodontists in order to analyse transpositions of teeth and their treatment. The results of this study confirm that most transpositions are maxillary canine/premolar transpositions. These transpositions were found to be often associated with other dental abnormalities (such as agenesis and peg-shaped laterals). Considerable evidences supports they are genetic in origin, but, in accordance with the demands of evidence-based science, further study is needed to prove it. The results suggest that most practitioners try to correct transposition despite the many difficulties involved. Early diagnosis did not reduced treatment time nor diminish difficulties.

Bicuspid↗
PubMed1999

Mandibular third molars: oral surgeons' assessment of the indications for removal.

The aim was to examine oral surgeons' assessment of the indications for removal of mandibular third molars. Questionnaires were distributed to seven oral and maxillofacial surgery clinics. The oral surgeons were asked to record whether or not there was associated disease. Three other factors were recorded: patient's age, and angular position and extent of eruption of the molars. The strength of the indication for removal was rated on a visual analogue scale (VAS) where 0= weakest and 100= strongest indication for removal. The results were based on data from 666 molars: 118 (18%) had no disease, 465 (70%) had one associated disease, 77 (11%) had two and 6 (1%) had three. The indication for removal as expressed by the mean VAS for molars with no disease was assessed to be weaker (P<0.05) than that for molars with one, two, or three diseases. The only factor that influenced the indication for removal in molars with no disease was the patient's age.

Adolescent↗
PubMed2000

Patterns and appropriateness of referral from general dental practice to specialist oral and maxillofacial surgical services.

In this study we investigated patterns of referral and appropriateness of referrals to specialist oral and maxillofacial surgery services, using postal questionnaires and referral letters. The most common reasons for referral were the expected difficulty of the operation, the medical condition of the patient and the lack of facilities for general anaesthesia. Most referrals were made to the oral and maxillofacial surgery department of a general hospital but almost three-quarters of the respondents stated that they would refer patients to specialist surgical dentistry practices in the future. Few referrals to a university department of oral and maxillofacial surgery were considered to be inappropriate, nor were requests for a particular type of anaesthesia. Any future transfer from secondary to primary care for oral surgery may be hindered by the reduction in facilities for general anaesthesia in the primary care setting.

Adult↗
PubMed2000

Use of theatre time for dentoalveolar operations under general anaesthesia.

Efficient use of hospital resources is essential if waiting lists are to be reduced. We undertook this study because there seems to be little information on the use of theatre time for dentoalveolar surgery under general anaesthesia. The time taken for each sequence of events (from start of case, induction, operation to recovery, and so on) for each patient was recorded. Of the 30 lists examined, 22 lists (73%) finished on time or early, and 8 lists (27%) ran late. The time spent operating occupied less than 50% of theatre time available. The 'total time' for each case was increased (by about 10 minutes a patient) when a junior anaesthetist was anaesthetizing rather than a consultant. The overall time used per list was 79% with the remaining 21% of the list being 'unused'. Where these lists did over-run, then this was usually because the operation took longer, although grade of anaesthetist was a factor. We identified several areas in which efficiency could be improved.

Analysis of Variance↗
PubMed2001

Investigation and medical management of trigeminal neuralgia by consultant oral and maxillofacial surgeons in the British Isles.

Trigeminal neuralgia is an extremely painful affliction of the face that is treated by various specialists including oral and maxillofacial surgeons. Some aspects of its management remain controversial, including screening for secondary trigeminal neuralgia, and the monitoring of treatment with carbamazepine. There is, however, little information available about current practice. A postal questionnaire was sent to 254 fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) about v arious aspects of the management of trigeminal neuralgia. One hundred and seventy nine replies (70%) were received. Orofacial and cranial nerve examinations were undertaken by the majority of surgeons, but most did not routinely arrange computed tomograp hy or magnetic resonance imaging for all patients, nor did they refer the patient to a neurologist. In contrast with current recommendations, warnings about the adverse effects of carbamazepine were given by only a few surgeons, while most routinely monitored full blood counts.

Anticonvulsants↗
PubMed2002

Routine follow-up after periradicular operations: current practice in UK hospitals.

Questionnaires were circulated to all Fellows of the British Society of Oral and Maxillofacial Surgeons in 1999, 75% of whom replied (n = 194). There was a wide range of responses for both the timing of review appointments and the taking of radiographs. Most patients were first followed up 1 week after operation (46%), but 38% were reviewed in the second week. Five surgeons did not review patients at all and two did not review until 6 or 9 months, respectively. Nearly two-thirds routinely offered a second follow-up appointment but only 14% offered more than two, the maximum being seven. Most arranged postoperative radio-graphs but the timing ranged from immediately postoperatively to 1 year after the procedure. Less than one-third requested a second postoperative radiograph between 1 month and 1 year. The largest disparity was in the time of discharge to the general dental practitioner, which ranged from immediately to 5 years, the most popular time of discharge being at 3 months. The wide variations may reflect unnecessary recall of patients and misuse of valuable clinical time.

Apicoectomy↗