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A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners; secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs); pain; and extraction. Cumulative costs were related to each of the trial's outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist's time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P < 0.05) per child. When all health care costs were compared, the intervention group's mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P < 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39-£79.52). Sensitivity analyses did not materially affect the study's findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention delivered at the practice level in the context of a state-funded dental service (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119). [ABSTRACT FROM AUTHOR]

A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners; secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs); pain; and extraction. Cumulative costs were related to each of the trial's outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist's time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P < 0.05) per child. When all health care costs were compared, the intervention group's mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P < 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39-£79.52). Sensitivity analyses did not materially affect the study's findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention delivered at the practice level in the context of a state-funded dental service (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119). [ABSTRACT FROM AUTHOR]

We conducted a parallel group randomized controlled trial of children initially aged 2 to 3 y who were caries free, to prevent the children becoming caries active over the subsequent 36 mo. The setting was 22 dental practices in Northern Ireland, and children were randomly assigned by a clinical trials unit (CTU) (using computer-generated random numbers, with allocation concealed from the dental practice until each child was recruited) to the intervention (22,600-ppm fluoride varnish, toothbrush, 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized, evidence-based prevention advice) or advice-only control at 6-monthly intervals. The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were number of decayed, missing, or filled teeth (dmfs) in caries-active children, number of episodes of pain, and number of extracted teeth. Adverse reactions were recorded. Calibrated external examiners, blinded to the child's study group, assessed the status of the children at baseline and after 3 y. In total, 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 intervention, 547 control) were included in the final analyses. Eighty-seven percent of intervention and 86% of control children attended every 6-mo visit ( P = 0.77). A total of 187 (34%) in the intervention group converted to caries active compared to 213 (39%) in the control group (odds ratio, 0.81; 95% confidence interval, 0.64-1.04; P = 0.11). Mean dmfs of those with caries in the intervention group was 7.2 compared to 9.6 in the control group ( P = 0.007). There was no significant difference in the number of episodes of pain between groups ( P = 0.81) or in the number of teeth extracted in caries-active children ( P = 0.95). Ten children in the intervention group had adverse reactions of a minor nature. This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119). [ABSTRACT FROM AUTHOR]

Orafi I, Worthington HV, Qualtrough AJE, Rushton VE. The impact of different viewing conditions on radiological file and working length measurement. International Endodontic Journal,  43, 600–607, 2010. Aim To determine the effect of different viewing conditions and observer experience upon the accuracy of file and working length measurements using analogue intra-oral radiographs. Methodology Twenty-five observers from a range of clinical backgrounds examined working length analogue periapical radiographs of 30 extracted teeth. Each participant measured both file (FL) and working length (WL) on each of the radiographs using three different viewing conditions consisting of a viewing box, a viewing box with film masking and a viewing box with film masking and ×2 magnification. Statistical analysis was conducted to derive interobserver reliability by intraclass correlation coefficients, and multiple linear regression models were fitted to compare the mean differences between the joint consensus between specialists and estimated values for file length and working length for each of the three viewing conditions. Results Multiple regressions models were fitted and found significant differences between the use of the viewing box alone and a viewing box with masking (FL P = 0.001; WL P < 0.001) and the use of the viewing box alone and with a viewing box employing masking and magnification (FL P < 0.001; WL P = 0.002). Intraclass correlation coefficient showed a high level of agreement between all observers; however, no statistically significant differences were found between the five observers groups for either mean file length or working length values. Conclusions The results of this study are in agreement with National and European guidelines, which recommend the use of a viewing box, magnification and masking for radiographic interpretation. [ABSTRACT FROM AUTHOR]

Complete dentures can be produced with different types of occlusal forms. There is some evidence to suggest that it may be advantageous to provide complete dentures with cusped posterior teeth. The aim of this research was to compare the levels of subject satisfaction with 3 types of posterior occlusal forms for complete dentures, in a randomized cross-over trial design. Forty-five participants were randomly assigned 3 sets of complete dentures with different posterior occlusal forms (zero-degree, anatomic, and lingualized occlusions). Subjective data were collected according to visual analogue scales after 8 weeks of denture-wearing. Statistical analysis consisted of repeated-measures analysis of variance, followed by paired t tests. Lingualized and anatomic occlusal forms were perceived to be significantly superior in terms of chewing ability, when compared with zero-degree posterior occlusal surfaces. [ABSTRACT FROM AUTHOR]

Complete dentures can be produced with different types of occlusal forms. There is some evidence to suggest that it may be advantageous to provide complete dentures with cusped posterior teeth. The aim of this research was to compare the levels of subject satisfaction with 3 types of posterior occlusal forms for complete dentures, in a randomized cross-over trial design. Forty-five participants were randomly assigned 3 sets of complete dentures with different posterior occlusal forms (zero-degree, anatomic, and lingualized occlusions). Subjective data were collected according to visual analogue scales after 8 weeks of denture-wearing. Statistical analysis consisted of repeated-measures analysis of variance, followed by paired t tests. Lingualized and anatomic occlusal forms were perceived to be significantly superior in terms of chewing ability, when compared with zero-degree posterior occlusal surfaces. [ABSTRACT FROM AUTHOR]

Aim: To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. Objectives: To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting: Three general medical practices in east Cheshire, UK. Design: A randomized controlled trial. Method: Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. Results: Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. Conclusions: The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare three orthodontic archwire sequences. One hundred and fifty-four 10- to 17-year-old patients were treated in three centres and randomly allocated to one of three groups; A = 0.016-inch nickel titanium (NiTi), 0.018 x 0.025-inch NiTi, and 0.019 x 0.025-inch stainless steel (SS); B = 0.016-inch NiTi, 0.016-inch SS, 0.020-inch SS, and 0.019 x 0.025-inch SS; and C = 0.016 x 0.022-inch copper (Cu) NiTi, 0.019 x 0.025-inch CuNiTi, and 0.019 x 0.025-inch SS. At each archwire change anti for each arch, the patients completed discomfort Scores on a seven-point Likert scale at 4 hours, 24 hours, 3 days, and 1 week. Time in days and the number of visits taken to reach a 0.019 x 0.025 inch SS working archwires were calculated, A periapical radiograph of the upper left central incisor was taken at the start of the treatment and after placement of the 0.019 x 0.025-inch SS wire so root resorption could be assessed. There were no statisticallv significant differences between archwire sequences A, B, or C for patient discomfort (P > 0.05) or root resorption (P = 0.58). The number of visits required to reach the working archwire was greater for sequence B than for A (P = 0.012) but this could not be explained by the increased number of archwires used in sequence B. [ABSTRACT FROM AUTHOR]

Objective The primary aim was to evaluate the validity of a teledentistry system for screening new patient orthodontic referrals. The secondary aims were to evaluate whether the teledentistry system affected i) referral rates ii) inappropriate referral rates iii) number of failed appointments.Study design Randomised controlled trial.Sample Fifteen dental practices in Greater Manchester, UK, were randomly allocated to either a teledentistry test group (n = 8) or a control group (n = 7). They referred 327 patients over a 15 month period.Method Practitioners in the test group referred patients to one of two consultant orthodontists via a 'store and forward' teledentistry system consisting of photographs sent as email attachments. The decision to accept or not accept a referral on this basis was compared with the same decision choice when the same patient was subsequently seen on a new patient clinic. This measured the validity of the system with the clinic's decision used as the gold standard. Patients in the control group were referred using the usual letter system. Referral rates, inappropriate referrals and number of failed appointments were then compared between the teledentistry and control groups.Results The sensitivity (true positive value) of the teledentistry system was high at 0.80 with a positive predictive value of 0.92. The specificity (true negative value) was slightly lower at 0.73 with a negative predictive value of 0.50. The inappropriate referral rate for the teledentistry group was 8.2% and for the controls 26.2% (p = 0.037). There was no statistically significant difference in clinic attendance between teledentistry and control groups (p = 0.36).Conclusions Teledentistry is a valid system for positively identifying appropriate new patient orthodontic referrals. However, there is a risk that a patient is not accepted on the teledentistry system who would benefit from a full clinical examination. Teledentistry could be a significant factor in reducing the inappropriate referral rate. Patient participation in a teledentistry system does not appear to mean they are any more likely to attend their hospital appointment. [ABSTRACT FROM AUTHOR]

Aim To measure and compare the relationships between image quality and X-ray exposure for three types of intraoral imaging system (conventional film, phosphor plate system and CCD-based system). Methodology Kodak `Insight' P-speed film, Digora PMX (phosphor plate system) and Visualix USB (CCD system) were used to produce series of radiographic images of two tooth-bearing jaw specimens (maxillary molar and mandibular molar regions) at a range of X-ray exposures from 10 ms to 2000 ms (all at 6 mA and 60 kV). Digital images were viewed from a computer monitor and films viewed on a conventional light box. Five observers scored each image using a five- point subjective image quality scale (0-4). Results Optimum image quality (4) was seen for conventional film. Neither digital system achieved this score at any exposure, achieving in both cases a maximum mean score of 3.1 (adequate visualization). The two digital systems, however, provided adequate visualization at substantially lower exposure times. Dose reduction over conventional film for maximum quality images with Visualix USB was 20%, but for Digora PMX it was 70%. All three systems gave acceptable (quality score of two or higher) images over a broad range of exposures. Conclusions In terms of subjective image quality, P-speed film performed better than the two digital systems, but this must be weighed against the ability of the two digital systems to give adequate image quality at lower radiation doses. [ABSTRACT FROM AUTHOR]

Objectives This study investigated the bacterial and fungal contamination of used dental burs. A novel assay system for comparison of efficacy of pre-sterilisation cleaning techniques for dental burs was used to evaluate manual scrubbing, enzymic agents and washer-disinfectors.Methods Thirty dental burs contaminated during cavity preparation were analysed for micro-biological total viable counts and species of bacteria and fungi present. To simulate clinically contaminated burs, a culture of Streptococcus sanguis NCTC 7863 was used to inoculate unused dental burs, alone and combined with blood, saliva or a mixture of blood and saliva. Contaminated burs were subjected to six pre-sterilisation cleaning techniques and the log reduction in contamination achieved by each method was assessed.Results The microbial count from used dental burs ranged from 0 to 6.92×104 CFU ml-1. Many potentially pathogenic species were identified. The decontamination assay demonstrated that autoclaving alone was not sufficient to sterilise dental burs. Manual scrubbing in air was less efficacious than manual scrubbing under water (p<0.001). The most effective method of pre-sterilisation cleaning for dental burs was a washer-disinfector.Conclusions Enzymic agents are suitable for soaking contaminated dental burs immediately after use. Washer-disinfectors are recommended as the method of choice for pre-sterilisation cleaning of contaminated dental burs. [ABSTRACT FROM AUTHOR]

This study was designed to investigate the effectiveness of topical bupivacaine (0·25%) in reducing postoperative distress following extraction of teeth under general anaesthesia in children.The study was a double-blind randomized controlled trial.The study was conducted in a dental hospital.The sample comprised 135 children aged between 2 and 12 years of age who were undergoing outpatient general anaesthesia for simple dental extractions.The children were randomly allocated to one of two groups: the bupivacaine group (the study group) comprised 68 children whilst the sterile water group (the control group) comprised 67. Following the extraction of their teeth, children had swabs soaked in the appropriate solution placed over the exposed teeth sockets. A five-point face scale was employed by an independent observer to evaluate the distress for each child. Evaluation of distress was made preoperatively, on recovery from the general anaesthetic, and again, 15 min following recovery from the anaesthetic.There were no statistically significant differences between the mean distress scores for the bupivacaine and sterile water groups preoperatively, postoperatively or 15 min postoperatively. For both groups, however, there were significant increases in distress scores between the preoperative and 15 min postoperative assessment scores.Extraction of teeth under general anaesthesia does cause distress in children. There is no evidence that topical bupivacaine reduces this distress when compared to sterile water. [ABSTRACT FROM AUTHOR]

Orofacial pain is often persistent, but it is not clear why it lasts in some patients but not in others. We aimed to describe the natural course of orofacial pain in a general population sample over a four-year period and to identify factors that would predict the persistence of pain. A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (participation rate 74%), of whom 646 (26%) reported orofacial pain. Overall, 424 (79% adjusted participation rate) of these individuals participated at the four-year follow-up, of whom 229 (54%) reported orofacial pain and 195 (46%) did not report such pain. Persistent orofacial pain was associated with females, older age, psychological distress, widespread body pain, and taking medication for orofacial pain at baseline. These findings may have implications for the identification and treatment of patients with orofacial pain. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of providing free toothpaste containing either 1450 or 440 ppm F on caries experience in 5-year-old children living in areas with different levels of material deprivation. Five-year, examiner-blind, randomized, controlled, parallel-group, clinical trial. Children were randomly assigned to three groups. Setting: Health Districts in the north-west of England with high levels of dental caries. Clinical examinations were performed in schools during the period October 1999 to April 2000 when the children were 5–6 years old. Children from 3-month birth cohorts resident in nine, nonfluoridated health districts. Interventions: Toothpaste containing either 440 or 1450 ppm F and dental health literature posted at 3-month intervals and toothbrush provided annually from the age of 1–5 years. Comparison group received no intervention. Mean dmft and proportion of participants with dmft > 0, dmft ≥ 4, upper primary incisor caries and extraction of one or more primary teeth. Outcomes tabulated for quartiles of participants based on the distribution of the Townsend index of material deprivation. Results: A total of 3467 children were included in the final data analysis. The Townsend index was found to be useful in identifying groups of children with increased caries risk. Overall, participants in the program using the high-fluoride toothpaste had significantly ( P < 0.002) less caries than the comparison group with similar absolute reductions in mean dmft for the most- and least-deprived groups. Relative to the comparison group the association between deprivation and dental caries was changed so that in the most-deprived quartile those using the low-fluoride toothpaste tended to have less dental caries than the comparison group whereas in the least deprived they tended to have more. This difference in the association (slope) was statistically significant ( P < 0.05). Provision of both low- and high-fluoride toothpaste appeared to reduce the risk of extractions for participants in the most-deprived quartile ( P < 0.05). The relative benefits of the programmes supplying the two toothpastes considered in this study are different depending on the deprivation status of the participants. For the most-deprived groups postal provision of either a low- or high-fluoride toothpaste provides similar levels of benefit. In the less deprived groups only provision of the high-fluoride toothpaste provided a benefit. The absolute caries reduction seen for provision of the high-fluoride toothpaste was not related to the deprivation status and hence the programme did not reduce deprivation-related health inequalities. Targeting the programme using the methods employed in this study is unlikely to improve the effectiveness of the programme. [ABSTRACT FROM AUTHOR]

AimTo test the effectiveness of dental health educators in general dental practice.ObjectiveTo evaluate the effectiveness and cost of primary care trusts seconding dental health educators free of charge to suitable general dental practices to provide dental health counselling to mothers of regularly attending pre-school children at risk to caries.MethodTwo-cell, parallel group, cluster randomised, controlled clinical trial of two years' duration. Clinical setting: 30 general dental practices in North-West England. Participants: 269 mothers of 334 pre-school children. Interventions: Those in the test group were given visits to a dental health educator over a 2-year period to counsel mothers of at-risk, pre-school children. The rest were held as a control. Main outcome measures: Caries prevalence of the children and dental health knowledge, attitudes and toothbrushing skills of the parents. The full costs of the exercise were kept throughout. The statistical analysis controlled for the clustering of children within practices.ResultsAfter 2 years, 271 (81%) children and 248 (92%) mothers remained in the study. There was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. At the end of the study there was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. No difference in plaque levels was found. The mothers in the test group were more knowledgeable, had better attitudes towards the dental health of their offspring and better toothbrushing skills than those in the control. Each 2-hour session to counsel ten parents cost £40.ConclusionPrimary care trusts should carefully consider the cost value of seconding dental health educators to counsel parents of regularly attending, at-risk, pre-school children when considering such an option. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the quality of systematic reviews of effectiveness of interventions in dentistry. The Database of Abstracts of Reviews of Effectiveness and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews examining the effectiveness of interventions for oral, dental and craniofacial disorders and diseases. Sixty-five reviews were identified and assessed independently by two reviewers. The area most frequently evaluated within the reviews was pain relief/prevention (20/65, 31%) followed by caries and oral medicine. The quality assessment of the identified systematic reviews highlighted key areas where improvements could be made. One major weakness of the reviews was that the search strategies employed were not always adequate. Only 12 reviews (19%) demonstrated an attempt to identify all relevant studies. Other areas of weakness include the screening and quality assessment of primary studies, the pooling of data and examination of heterogeneity, and the interpretation of findings. This investigation shows that the quality of systematic reviews in dentistry could be improved. If future clinical decisions are to be based upon systematic reviews, it is imperative that the reviews address clinically relevant, focused questions and follow a ‘transparent’, well-designed protocol. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to conduct a systematic review of ceramic inlays, assess the quality of published clinical studies, and determine the clinical effectiveness of ceramic inlays compared to other forms of posterior restorations. Prospective clinical trials of ceramic inlays published from 1990 to 2001 were retrieved by electronic and hand searching. The methodological quality of each study was assessed by two calibrated reviewers using a standardised checklist. The clinical effectiveness of ceramic inlays was evaluated in terms of failure rate, postoperative pain, and aesthetics. The results were compared to those of other forms of posterior restorations by means of an odds ratio. Among 46 articles selected for quality assessment, only five (10.6%) reported randomised controlled trials and 15 (32.6%) presented controlled clinical trials. The remaining 26 papers (56.5%) were longitudinal clinical trials lacking control groups. Only three papers fulfilled the requirement for statistical analysis to evaluate the clinical effectiveness of ceramic inlays. The results indicate no significant differences in longevity or postoperative sensitivity between ceramic and other posterior restorations over assessment periods of up to 1 year. It is concluded that no strong evidence is available to confirm the clinical effectiveness of ceramic inlays in comparison to other posterior restorations. Greater attention is required to the design and reporting of studies to improve the quality of clinical trials of ceramic inlays. [ABSTRACT FROM AUTHOR]

Objectives To evaluate which orthodontic adhesives (a) bond orthodontic brackets to teeth more reliably and (b) are more effective at preventing decalcification. Data sources The search strategy for the literature review was carried out according to the standard Cochrane systematic review methodology. The Cochrane Clinical Trials Register and the Cochrane Oral Health Group Specialized Register were searched for randomized clinical trials and controlled clinical trials. All volumes that had not already been assessed by the Oral Health Group in the European Journal of Orthodontics, American Journal of Orthodontics, Journals of Orthodontics, and Angle Orthodontist were hand-searched. Inclusion and exclusion criteria were applied when considering the studies to be included in this review. Data selection The primary outcome measure was the failure of the orthodontic adhesive. A secondary outcome of decalcification occurring around the orthodontic bracket was also recorded, if data were available. Data extraction Two randomized clinical trials and one controlled clinical trial were identified that fulfilled all the inclusion and exclusion criteria. The trials compared: (a) light- and chemically-cured composite; (b) chemically-cured composite and conventional glass ionomer cement; and (c) chemically-cured composite and light-cured compomer. Data synthesis Each paper was quality assessed by two people independently. A qualitative analysis of the trials in the review is presented. The data presentation, for the majority of the trials, precluded the use of suggested Cochrane Health Group statistical analysis. Conclusions It is difficult to draw any conclusions from this review; however, suggestions are made for methods of improving future research involving orthodontic adhesives. [ABSTRACT FROM AUTHOR]

The objectives of this study were to determine whether oral prophylactic agents are superior to placebo or no treatment on the incidence of oral mucositis and oral candidiasis for patients with cancer. A Cochrane systematic review was conducted of randomized trials of oral (and topical) prophylactic agents for mucositis and oral candidiasis, anywhere in the world, among patients with cancer (excluding head and neck) who were receiving chemotherapy. Eleven studies were included in the meta-analysis for mucositis. Of the six prophylactic agents used for mucositis, only one--ice chips--was effective (relative risk 0.57, 95% CI 0.43 to 0.77). Fifteen studies were included in the meta-analysis for oral candidiasis. There is evidence that antifungal agents that are partially or fully absorbed from the gastrointestinal tract prevent oral candidiasis and that the partially absorbed agents may be more effective than the fully absorbed agents. The RR for partially absorbed agents was 0.13 (95% CI 0.06 to 0.27). In conclusion, there is weak and unreliable evidence that ice chips prevent mucositis. There is evidence that prophylactic use of antifungal agents, which are absorbed or partially absorbed from the gastrointestinal tract, reduce the clinical signs of oral candidiasis. [ABSTRACT FROM AUTHOR]

Abstract Aim This study aimed to measure and compare pH changes at apical and cervical sites on the external root surface of extracted teeth dressed with calcium hydroxide in two different formulations. Methodology Root canals of 45 single-rooted extracted human teeth were accessed and shaped using a step-down technique with rotary instrumentation. Standard cavities were prepared on the external root surface at specific apical and cervical sites. The teeth were randomly allocated to three groups. Teeth in group A were dressed with calcium hydroxide points, those in group B were dressed with an aqueous calcium hydroxide paste and teeth in group C were left unfilled. Following storage in humid conditions, the pH of the dentine at apical and cervical sites was measured at baseline and then at 24 h, 72 h, 1 week, 10 days, 2 weeks and 3 weeks. Results The pH of the root dentine at both apical and cervical sites was significantly greater (P < 0.001) in teeth dressed with aqueous calcium hydroxide paste compared with those dressed with calcium hydroxide points, when averaged out across all time periods. For all groups, there was a significant difference between the mean apical and cervical pH values for each tooth with lower values for the apical sites (P < 0.001). Conclusion The results of this study indicate that an aqueous calcium hydroxide paste was more effective than calcium hydroxide points at raising the pH on the external root surface of extracted teeth. [ABSTRACT FROM AUTHOR]

Aim To compare the rates of orthodontic space closure for: Active ligatures, polyurethane powerchain (Rocky Mountain Orthodontics, RMO Europe, Parc d'Innovation, Rue Geiler de Kaysersberg, 67400 Illkirch-Graffenstaden, Strasbourg, France) and nickel titanium springs. Sample Patients entering the space closure phase of fixed orthodontic treatment attending six orthodontic providers. Twelve patients received active ligatures (48 quadrants), 10 patients received powerchain (40 quadrants) and 11 patients, nickel-titanium springs (44 quadrants). Method Patients were randomly allocated for treatment with active ligatures, powerchain or nickel titanium springs. Upper and lower study models were collected at the start of space closure (To) and 4 months later (T1). We recorded whether the patient wore Class II or Class III elastics. Space present in all four quadrants was measured, by a calibrated examiner, using Vernier callipers at To and T1. The rate of space closure, in millimetres per month (4 weeks) and a 4-monthly rate, was then calculated. Examiner reliability was assessed at least 2 weeks later. Results Mean rates of space closure were 0.35 mm/month for active ligatures, 0.58 mm/month for powerchain, and 0.81 mm/month for NiTi springs. No statistically significant differences were found between any methods with the exception of NiTi springs showing more rapid space closure than active ligatures (P < 0.05). There was no effect of inter-arch elastics on rate of space closure. Conclusions NiTi springs gave the most rapid rate of space closure and may be considered the treatment of choice. However, powerchain provides a cheaper treatment option that is as effective. The use of inter-arch elastics does not appear to influence rate of space closure. [ABSTRACT FROM AUTHOR]

Objective: An audit study which examines patient's opinions on the efficiency of two analgesic regimes prescribed to them following dento-alveolar surgery in our Day Unit.Design: Single centre prospective study.Setting: Oral Surgery Day Case UnitSubjects: One-hundred-and-seventy-four adults undergoing routine dento-alveolar surgery under general anaesthetic were asked to assess their pain control (on a five point scale) 1 hour after surgery, at discharge from hospital and at 24 and 48 hours post-operatively. Post-operatively, patients received ibuprofen 400 mg three times daily for five days or two tablets of paracetamol 500 mg with codeine 30 mg six hourly for 5 days if they were allergic to aspirin or were asthmatics sensitive to aspirin. Patients were not given local anaesthesia intra or post-operatively.Results: Completed records were obtained for 161 (93%) patients. Ibuprofen was apparently adequate in controlling pain for 147 out of 161 patients but on further questioning 42 of these patients took supplemental analgesics and self-prescribed paracetamol or a paracetamol combination. Thirteen patients who were prescribed paracetamol with codeine had adequate pain control and did not take supplemental analgesics. One patient did not require any analgesics post-operativelyConclusion: Telephone contact with patients 24 and 48 hours post-surgery provides a valuable assessment of pain control following discharge from a day surgery unit. Ibuprofen offered satisfactory control of pain for 65% (95) of patients who underwent routine dento-alveolar surgery. Discharge prescriptions must be given with verbal and written instructions to ensure that patients take the correct dose and self-prescription is within safe doses. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether a standard Resuscitation Council (UK) ALS course is appropriate for primary care dentists or whether a course should be specifically designed for dentists.Design: Opinions canvassed by pre-course expectation and post-course evaluation questionnaires.Subjects: 23 West Pennine primary care dentists providing a general anaesthetic or conscious sedation service who attended an ALS course.Results: Knowledge and skills were rated on a 5-point scale from 1 (not important at all) to 5 (extremely important). Basic airway management (mean = 5) and anaphylaxis (mean = 4.9) scored the highest on the 'expectation' questionnaire. Rhythm recognition (P < 0.001), defibrillation (P = 0.007) and arrest algorithms (P = 0.047) were rated as significantly more important after the course than before. Knowledge about rhythm disorder management, cardiac pacing, post-resuscitation care, blood gas interpretation and bereavement were not considered to be so important either before or after the course.Conclusions: Despite rating some aspects as unimportant, all dentists stated that this course had been appropriate. They did not want a specially designed ALS course for dentistry. Taking exactly the same recognised course and assessments as other healthcare professionals and gaining the same certification was felt to be important to this group of dentists. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of direct access referrals with standard letter referrals, and also assess the impact of the direct access system on the primary care provider, secondary sector and from the patients perspective.Design: Surgical and anaesthetic guidelines were agreed and 12 general dental practitioners were recruited to participate in the study. Each practitioner was given 100 envelopes which contained randomly allocated 50 direct and 50 standard referrals. For direct referrals, GDPs completed a pre-operative assessment and obtained an operation date by telephone from the day case unit while the patient was in the surgery. The clinical history sheet was faxed to the day unit and the radiographs posted. The only contact the patient had with the hospital was on the day of surgery. Standard referral patients were referred in the traditional way with a referral letter being sent to an out-patient clinic. Evaluation of the effectiveness of the direct referral system versus standard letter method were made via completion of questionnaires by the patients, dental practitioners, hospital clinicians, day case anaesthetist and co-ordinator.Setting: The study was carried out over 2 years commencing in 1997 at the Oral Surgery Day Case Unit at Manchester Royal Infirmary.Results: A greater number of direct access referrals (409; 90%) were treated in comparison with (312; 75%) standard referrals (P < 0.001). Eighty nine per cent of direct access records were adequate pre-operatively. More than 70% of dentists and hospital clinicians preferred the direct access referral method. Sixty-three per cent of standard letter patients were satisfied with their mode of referral compared with 87% of direct access patients.Conclusions: Given appropriate guidelines dental practitioners are able to refer directly to oral surgery day case operation lists. This has proved to be the favoured method of referral for dental practitioners, the secondary sector and patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate GDP opinions of the current referral system and to investigate the need and demand for telemedicine in oral surgery referrals.Design: Postal questionnaire.Setting: 400 GDPs in Greater Manchester.Results: 84% participation rate. 48% were not satisfied overall with the service of their current specialist oral surgery referral site. The principal reason was the length of the waiting time for consultation and treatment. Distance for patients to travel to the specialist unit was also of concern, even though most patients (89%) travelled short distances (return journey of twelve miles or less). 23% of respondents wished to improve their ability to communicate with the oral surgeon and 70% wanted involvement in the patient consultation. Both of these requirements were more likely in younger practitioners.Conclusion: There is a need and demand for change in the referral system for oral surgery specialist care. Telemedicine could conceivably be one way to improve access to specialist oral surgery care. [ABSTRACT FROM AUTHOR]

Aims: To determine whether general dental practitioners would find seminars on research methods in primary care research of interest and whether they would be stimulated to plan their own research.Method: Questionnaire with both open and closed questions distributed to participants at the end of the seminars. 10 seminars in locations throughout the north west of England were planned.Results: 98 dentists attended the seminars of whom 81 returned questionnaires, giving a response rate of 82.6%. More than 60% found the seminars and the specially developed teaching manual very useful. However there was somewhat less enthusiasm for undertaking research projects.Conclusions: The findings suggest that some GDPs are interested in primary care research but are not keen to initiate or plan research themselves. [ABSTRACT FROM AUTHOR]

Objective: To investigate current GDP oral surgery referral patterns given the anticipated change since the introduction by the General Dental Council of the specialty of surgical dentistry.Design: Postal questionnaire.Setting: 400 GDPs in Greater Manchester.Results: 84% participation rate. 69% of dentists made a referral because of anticipated difficulty of surgery and 49% because of the complex nature of the patients' medical history. Practitioners who had undergone some oral surgery postgraduate training were more likely to undertake more surgery in their practices (P < 0.01) and to refer more patients for specialist care (P < 0.05). While female practitioners rated their own surgical confidence less highly than male practitioners (P < 0.001), and younger practitioners less than their older colleagues (P < 0.05), there was no significant difference in the number of referrals made.Conclusion: The most common reasons for referral were the anticipated difficulty of surgery and patient medical compromise. There was a wide variation between practitioners in the number of patients referred for specialist care. Postgraduate oral surgery training was identified as a factor contributing to this variation. Other practitioner variables, such as sex, experience and type of practice were not found to contribute. [ABSTRACT FROM AUTHOR]

Objective: To assess the quality of panoramic radiographs in a sample of general dental practices, to determine the relative frequency of errors and to identify those errors directly responsible for diagnostically inadequate images.Materials and Methods: Examination of 1,813 panoramic radiographs obtained from 41 general dental practitioners and recording of faults. The study was carried out in 1998. Radiographs were judged as being 'excellent', 'diagnostically acceptable' or 'unacceptable'.Results: Only 0.8% of films were 'excellent', 66.2% were 'diagnostically acceptable' and 33% were 'unacceptable'. The most common faults which directly contributed to failure of the radiographs were antero-posterior positioning errors, low density and low contrast.Conclusions: The quality of panoramic radiographs was considerably lower than standards recently set for primary dental care. The quality of panoramic radiography could be improved by careful attention to radiographic technique and processing. [ABSTRACT FROM AUTHOR]

The article presents a study investigating some features of communicating health messages to young people who are below average in reading and learning abilities. The effective communication with such persons can be influenced by three major factors: their psychosocial needs, the quality of the message channel, and the suitability of the educational material. It was found essential in the study that the health educators consider the psychosocial needs but the factors such as peer group norms and socio-cultural background need special attention.

The aim of this study was to determine the influence of a range of patient and dentist factors on the prescription of bitewing radiography. A postal questionnaire of general dental practitioners working in the Birmingham and Manchester areas of England was used. Dentists were requested to score the influence of 15 factors upon their decision whether or not to take bitewing radiographs. Some of these factors were chosen to represent accepted "high caries risk" factors, some "low risk" factors, while others were chosen as they should be irrelevant to prescription of bitewing radiographs. There was a questionnaire response of 70.8%. Dentists recognized accepted high caries risk factors as being an indicator for bitewing radiography but the influence of low caries risk factors was less clear. Only "good oral hygiene" and the presence of "few restorations" were perceived as relevant to bitewing prescription, while fissure sealants were seen as an influence in favour of radiography by almost one third of dentists. Dentists tended to be influenced in their radiographic practice by the opinions of patients and fears of medico-legal consequences. Pregnancy was seen as contra-indicatory for bitewings by almost all dentists. These results suggest that greater emphasis should be placed upon radiographic selection criteria in dental education. [ABSTRACT FROM AUTHOR]

The main aim of this study was to compare the intervals between initial and recall bitewing radiography recommended by general dental practitioners (GDPs) with those advocated in published guidelines. A questionnaire containing eight clinical scenarios was distributed to GDPs in two areas of England. Birmingham (fluoridated) and Manchester (non-fluoridated). The response rate was 70.8%. There was considerable agreement (>66.0%) with recommended guidelines for all low caries risk scenarios, but in three out of the four high caries risk scenarios a minority of dentists were in agreement (<49.5%). In high caries risk scenarios there was a tendency to over prescription with adult patients and under-prescription for patients in the mixed dentition. For all low risk scenarios except the youngest patient, there was a significantly greater agreement with the guidelines amongst Birmingham dentists, with the Manchester group having a greater tendency to over-prescription. This difference may be related to the effects of fluoridation of the water supply in the Birmingham area. There was generally greater agreement with the guidelines amongst younger dentists, with their older colleagues tending to under-prescription. The results suggest that greater emphasis on selection criteria in continuing education of dentists is required. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effectiveness of a dentifrice containing 0.3% triclosan, 2.0% copolymer and 0.243% sodium fluoride (Colgate Total®) in the prevention of periodontal attachment loss in adolescents. A 3-year. double-blind, randomised, controlled, clinical trial was conducted on 641 adolescents, initially aged 11-13 years. The participants were enrolled from schools in economically deprived areas of Manchester. England. which had a high % of Asian pupils originating from India, Pakistan and Bangladesh. After the baseline examination, which included assessments of pocket depth. attachment loss and subgingival calculus, the adolescents were randomly allocated to use either a triclosan/copolymer or control dentifrice. The control was identical to the test dentifrice with the exception that it did not contain triclosan/copolymer. Participants were re-examined after 18 and 36 months. After 3 years. a total of 239 adolescents remained in the test and 241 in the control group. The prevalence of attachment loss increased from 2% at baseline to 24% after 3 years. The mean increment of attachment loss during the study was 0.025 mm per site in the control group and 0.018 mm per site in the test group. A linear regression model showed a statistically significant difference in attachment loss between the test and control group. in adolescents with high mean pocket depths at baseline. No adverse effects attributable to the test or control dentifrices were observed during the study This study has demonstrated that unsupervised use of a triclosan/copolymer dentifrice can significantly reduce periodontal attachment loss. particularly in adolescents with high mean pocket depths. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Periodontology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Periodontology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary. The purposes of the study were threefold: to compare salivary levels of mutans streptococci and Lactobacillus in 140 5-year-old children from two ethnic groups, to correlate caries experience of each group with bacterial counts, and to determine levels of infectivity which could indicate high caries activity in young children. Pakistani-Muslim and white Caucasian children were paired, matched for age, gender and caries experience. There were no significant differences in mutans streptococci or Lactobacillus levels between the two ethnic groups. However, strong correlations were found between caries experience and levels of both mutans streptococci and Lactobacillus in each ethnic group. Furthermore, mutans streptococci and Lactobacillus levels correlated strongly with one another. For detection of high caries activity, the optimum screening levels of bacteria were>105 cfu/ml for mutans streptococci (sensitivity 78% and specificity 86%) and>104 cfu/ml for Lactobacillus (sensitivity 82% and specificity 89%). Résumé. Microflora bactérienne et expérience carieuse chez les enfants de deux groupes ethniques Le propos de cette étude est triple: comparer le taux de streptrocoques mutans et de lactobacilles chez 145 enfants de deux groupes ethniques, corréler l'expérience carieuse de chaque groupe avec le comptage bactérien et déterminer le niveau infecteux qui pourrait indiquer une activité carieuse élevée chez de jeunes enfants. Les enfants pakistanais musulmans et caucasiens blancs ont été appariés, assortis par âge, sexe et expérience carieuse. Il n'y avait pas de différence significative entre le taux de streptocoques mutans et de lactobacilles entre les deux groupes ethniques. Mais des corrélations fortes entre l'expérience carieuse et le niveau de streptocoques mutans et de lactobacilles dans chaque groupe ethnique. De plus, le taux de streptocoques mutans et de lactobacilles était corrélé l'un avec l'autre. Pour détecter une activité carieuse élevée, les niveaux optima de bactéries sont supérieurs à 105 cfu/ml pour le streptocoque mutans (sensibilité 78% et spécificité 86%) et supérieure à 104 cfu/ml pour le lactobacille (sensibilité 82% et spécificité 89%). Zusammenfassung. Die Mikroflora des Speichels und Kariesaktivität 5 jähriger Kinder aus 2 verschiedenen ethnischen Gruppen Der Zweck dieser Studie war 3 fachig: Ein Vergleich zwischen der Anzahl von Streptococci mutans und Lactobacillus in 140, 5 Jahr alten Kinder aus 2 ethnischen Gruppen, die Korrelation Karieserfahrung jeder Gruppe mit der Bakterienanzahl, und die Bestimmung von Infektionsebenen welche eine hohe Kariesaktivität bei Kleinkindern indizieren. Paktistanische-Muslims und weisse Kinder wurden verglichen, angepasst bezüglich Alter und Karieserfahrung. Man fand keinen signifikanten Unterschied bei den mutans Streptococci oder Lactobacillus-Ebenen zwischen den beiden Gruppen. Hingegen fand man eine markante Korrelatien zwischen den Kariesanfall und den Höhen der Streptococci mutans und den Lactobacillus in beiden Gruppen. Ebenso fand man dass die Streptococci mutans und Lactobacillus Eban stark miteinander korreheren für die Feststellung einer hohen Kariesaktivität, die optimale Anzahl der Bakterien dafür waren>104 cfu/ml Streptococci mutans (Sensibilität 78% und Spezifität 86%) unhd>105 cfu/ml für Lactobacillus (Sensibilität 82% und Spezifität 89%). Resumen. Microflora salival y prevalencia de caries en niños de 5 años de edad en dos grupo étnicos Los objetivos del estudio fueron: (1) comparar los niveles salivales de estreptococo mutans y el lactobacilo en 140 niños de 5 años de edad de dos grupos étnicos, (2) correlacionar la prevalencia de caries de cada grupo con el recuento bacteriano, y (3) determiner los niveles de infección que pudieran indicar una alta actividad cariosa en niños. Niños pakistanies-musulmanes y blancos caucásicos fueron apareados y distribuidos por edad, sexo y prevalencia de caries. No hubo diferencia significativa en los niveles de estreptococo mutans y lactobacilo entre los dos grupos étnicos. Sin embargo, hubo una alta correlación entre la prevalencia de caries los niveles de estreptococo mutans y lactobacilo en cada grupo étnico. Además, los niveles de estreptococo mutans y lactobacilo tuvieron gran correlaión entre cada uno. Para la detección de una alta actividad cariosa, los niveles bacterianos óptimos fueron entre>105 cfu/ml−1 para el estreptococo mutans (sensitividad 78% y especificidad 86%) y>104 cfu/ml−1 para el lactobacilo (sensitividad 82% y especificidad 89%). [ABSTRACT FROM AUTHOR]

An empirical investigation was carried out on data from four caries clinical trials of subjects who were initially 11 to 12 years old. The three baseline variables suggested by Adkins (1977), as possibly being related to caries increment, were each calculated on specific groupings of teeth, and these were then considered as predictor variables for the dependent variable, caries increment. A gain in efficiency of approximately 20% was obtained when an analysis of covariance was used with these predictor variables, over a straightforward analysis of variance. However, this was only slightly more efficient than using baseline DMFS as a covariable. This investigation did not support the results of initial work done by Adkins (1977). [ABSTRACT FROM AUTHOR]

This article presents a speech by P. J. Holloway and H. V. Worthington, delivered at a meeting of the U.S. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research held at the University of Iowa, in which they discussed the role of Institution Review Boards (IRB's) in promoting medical ethics, ethical considerations of the randomized clinical trial (RCT), and ethical considerations of dental caries research.

The aim of this in vitro study was to evaluate the ability of a dental subtraction radiography system to quantitatively detect differences in density between radiographic image pairs. Four periapical radiographs were taken of the upper first permanent molars on 5 human skulls using the Digora radiographic imaging system. The 4 images were a "baseline" image and 3 containing test objects consisting of either 0.5, 1 or 2 mm thick aluminium cylinders, 2.5 mm in diameter. Semi-automated image processing software was used to "warp" the 3 images with test objects into the same geometric/density registration as the corresponding baseline image using a process called patch minimization. "Difference" images were then produced and their contrast stretched. For regions of interest, with and without test objects present, the difference in density between the baseline and "test object" images was calculated using a reference aluminium step wedge. The test objects were clearly visible in all the "difference" images. The mean difference between the actual and estimated volume of the test object was 0.31 (95% CI [-0.55, 1.17]) mm3 Al. There was a strong association (r=0.83) between the actual and estimated aluminium volumes. It is concluded that this system provides adequate precision for clinical evaluation. [ABSTRACT FROM AUTHOR]

'Immediate' implants are placed in dental sockets just after tooth extraction. 'Immediate-delayed' implants are those implants inserted after weeks up to about a couple of months to allow for soft tissue healing. 'Delayed' implants are those placed thereafter in partially or completely healed bone. The potential advantages of immediate implants are that treatment time can be shortened and that bone volumes might be partially maintained thus possibly providing good aesthetic results. The potential disadvantages are an increased risk of infection and failures. After implant placement in postextractive sites, gaps can be present between the implant and the bony walls. It is possible to fill these gaps and to augment bone simultaneously to implant placement. There are many techniques to achieve this but it is unclear when augmentation is needed and which could be the best augmentation technique. To evaluate success, complications, aesthetics and patient satisfaction between 'immediate', 'immediate-delayed' and 'delayed' implants. To evaluate whether and when augmentation procedures are necessary and which is the most effective technique. The Cochrane Oral Health Group's Trials Register (to 2 June 2010), CENTRAL ( The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 - 2 June 2010) and EMBASE via OVID (1980 - 2 June 2010) were searched. Several dental journals were handsearched. Randomized controlled trials (RCTs) comparing immediate, immediate-delayed and delayed implants, or comparing various bone augmentation procedures around the inserted implants, reporting the outcome of the interventions to at least 1 year after functional loading. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs). The statistical unit of the analysis was the patient. Fourteen eligible RCTs were identified but only 7 trials could be included. Four RCTs evaluated implant placement timing. Two RCTs compared immediate versus delayed implants in 126 patients and found no statistically significant differences. One RCT compared immediate-delayed versus delayed implants in 46 patients. After 2 years patients in the immediate-delayed group perceived the time to functional loading significantly shorter, were more satisfied and an independent blinded assessor judged the level of the peri-implant marginal mucosa in relation to that of the adjacent teeth as more appropriate (RR = 1.68; 95% CI 1.04 to 2.72). These differences disappeared 5 years after loading but significantly more complications occurred in the immediate-delayed group (RR = 4.20; 95% CI 1.01 to 17.43). One RCT compared immediate with immediately delayed implants in 16 patients for 2 years and found no differences. Three RCTs evaluated different techniques of bone grafting for implants immediately placed in extraction sockets. No statistically significant difference was observed when evaluating whether autogenous bone is needed in postextractive sites (1 trial with 26 patients) or which was the most effective augmentation technique (2 trials with 56 patients). There is insufficient evidence to determine possible advantages or disadvantages of immediate, immediate-delayed or delayed implants, therefore these preliminary conclusions are based on a few underpowered trials often judged to be at high risk of bias. There is a suggestion that immediate and immediate-delayed implants may be at higher risks of implant failures and complications than delayed implants. On the other hand the aesthetic outcome might be better when placing implants just after teeth extraction. There is not enough reliable evidence supporting or refuting the need for augmentation procedures at immediate implants placed in fresh extraction sockets or whether any of the augmentation techniques are superior to the others. [ABSTRACT FROM AUTHOR]

Background: Treatment of cancer is increasingly effective but associated with short and long-term side effects. Oral side effects, including oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them. Objectives: To assess the effectiveness of interventions for treating oral mucositis or its associated pain in patients with cancer receiving chemotherapy or radiotherapy or both. Search strategy: Computerized searches of Cochrane Oral Health Group’s Trials Register; Cochrane Pain, Palliative and Supportive Care Group’s Trials Register; CENTRAL; MEDLINE and EMBASE were undertaken. Reference lists from relevant articles were searched and the authors of eligible trials were contacted to identify trials and obtain additional information. Date of the most recent searches June 2006: CENTRAL (The Cochrane Library 2006, Issue 2). Selection criteria: All randomized controlled trials comparing agents prescribed to treat oral mucositis in people receiving chemotherapy or radiotherapy or both. Outcomes were oral mucositis, time to heal mucositis, oral pain, duration of pain control, dysphagia, systemic infection, amount of analgesia, length of hospitalization, cost and quality of life. Data collection and analysis: Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomization, blindness and withdrawals. Quality assessment was carried out on these three criteria. The Cochrane Oral Health Group statistical guidelines were followed and risk ratio (RR) values calculated using fixed effect models. Main results: Twenty-six trials involving 1353 patients satisfied the inclusion criteria. Four agents, each in single trials, were found to be effective for improving (allopurinol RR 3.33, 95% confidence interval (CI) 1.06 to 10.49; granulocyte macrophage-colony stimulating factor RR 4.23, 95% CI 1.35 to 13.24; immunoglobulin RR 1.81, 95% CI 1.24 to 2.65; human placentral extract RR 4.50, 95% CI 2.29 to 8.86) or eradicating mucositis (allopurinol RR 19.00, 95% CI 1.17 to 307.63). Three of these trials were rated as at moderate risk of bias and one as at high risk of bias. The following agents were not found to be effective: benzydamine HCl, sucralfate, tetrachlorodecaoxide, chlorhexidine and ‘magic’ (lidocaine solution, diphenhydramine hydrochloride and aluminum hydroxide suspension). Six trials compared the time to heal and mucositis was found to heal more quickly with two interventions: granulocyte macrophage-colony stimulating factor when compared to povidone iodine, with mean difference −3.5 days (95% CI −4.1 to −2.9) and allopurinol compared to placebo, with mean difference −4.5 days (95% CI −5.8 to −3.2). Three trials compared patient controlled analgesia (PCA) to the continuous infusion method for controlling pain. There was no evidence of a difference, however, less opiate was used per hour for PCA, and the duration of pain was shorter. One trial demonstrated that pharmacokinetically based analgesia (PKPCA) reduced pain compared with PCA: however, more opiate was used with PKPCA. Authors’ conclusions: There is weak and unreliable evidence that allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin or human placental extract improve or eradicate mucositis. There is no evidence that patient controlled analgesia (PCA) is better than continuous infusion method for controlling pain, however, less opiate was used per hour, and duration of pain was shorter, for PCA. Further, well designed, placebo-controlled trials assessing the effectiveness of allopurinol mouthwash, granulocyte macrophage-colony stimulating factor, immunoglobulin, human placental extract, other interventions investigated in this review and new interventions for treating mucositis are needed. [ABSTRACT FROM AUTHOR]

The article reports on the study that evaluates to ability Electronic Carries Monitor (ECM) to predict the development of dentine caries in the occlusal surfaces of second permanent molar teeth. It shows that ECM has the capacity to detect early, non-cavitated lesions which can potentially remineralise. It suggests that ECM was a good predictor of the surfaces that would develop caries or be restored during an 18 month period.

An abstract is presented for a systematic review of research about the therapeutic use of hyperbaric oxygen for irradiated dental implant patients.

Objectives: To gather information on the types of panoramic x-ray equipment used in NHS dental practice and whether dentists satisfy the legal requirements for safety, to determine which practice personnel take panoramic radiographs and to assess the prevalence of the practice of 'routine' panoramic radiography among NHS dentists.Design: Postal questionnaire survey of general dental practitioners carried out during 1997 in selected FHSAs in England and Wales.Results: 542 dentists returned the questionnaire, a 73.3% response. Panoramic x-ray equipment ranged in age from 27 years old to new, with 42.2% exceeding 10 years in age. The overwhelming majority of GDPs satisfied the requirement for regular maintenance and surveying of equipment. Almost all dentists (95.9%) performed a history and clinical examination prior to panoramic radiography but 42% practised 'routine screening' of new adult patients. A substantial proportion (36.7%) of dentists used unqualified personnel to take panoramic radiographs.Conclusions: While some aspects of this study give reassurance about the prevalence of good practice, widespread panoramic screening and using unqualified staff to take radiographs causes concern. These findings have implications for educators and for those involved in maintaining clinical standards. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Periodontology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Dental caries in the expanding elderly, predominantly-dentate population is an emerging public health concern. Elderly individuals with heavily restored dentitions represent a clinical challenge and significant financial burden for healthcare systems, especially when their physical and cognitive abilities are in decline. Prescription of higher concentration fluoride toothpaste to prevent caries in older populations is expanding in the UK, significantly increasing costs for the National Health Services (NHS) but the effectiveness and cost benefit of this intervention are uncertain. The Reflect trial will evaluate the effectiveness and cost benefit of General Dental Practitioner (GDP) prescribing of 5000 ppm fluoride toothpaste and usual care compared to usual care alone in individuals 50 years and over with high-risk of caries. Methods/design: A pragmatic, open-label, randomised controlled trial involving adults aged 50 years and above attending NHS dental practices identified by their dentist as having high risk of dental caries. Participants will be randomised to prescription of 5000 ppm fluoride toothpaste (frequency, amount and duration decided by GDP) and usual care only. 1200 participants will be recruited from approximately 60 dental practices in England, Scotland and Northern Ireland and followed up for 3 years. The primary outcome will be the proportion of participants receiving any dental treatment due to caries. Secondary outcomes will include coronal and root caries increments measured by independent, blinded examiners, patient reported quality of life measures, and economic outcomes; NHS and patient perspective costs, willingness to pay, net benefit (analysed over the trial follow-up period and modelled lifetime horizon). A parallel qualitative study will investigate GDPs' practises of and beliefs about prescribing the toothpaste and patients' beliefs and experiences of the toothpaste and perceived impacts on their oral health-related behaviours. Discussion: The Reflect trial will provide valuable information to patients, policy makers and clinicians on the costs and benefits of an expensive, but evidence-deficient caries prevention intervention delivered to older adults in general dental practice. Trial registration: ISRCTN: 2017-002402-13 registered 02/06/2017, first participant recruited 03/05/2018. Ethics Reference No: 17/NE/0329/233335. Funding Body: Health Technology Assessment funding stream of National Institute for Health Research. Funder number: HTA project 16/23/01. Trial Sponsor: Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL. The Trial was prospectively registered. [ABSTRACT FROM AUTHOR]

Background: Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in the USA in 1945 and is currently practised in about 25 countries around the world; health authorities consider it to be a key strategy for preventing dental caries. Given the continued interest in this topic from health professionals, policy makers and the public, it is important to update and maintain a systematic review that reflects contemporary evidence. Objectives: To evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries. To evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. Search methods: We searched the following electronic databases: The Cochrane Oral Health Group's Trials Register (to 19 February 2015); The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2015); MEDLINE via OVID (1946 to 19 February 2015); EMBASE via OVID (1980 to 19 February 2015); Proquest (to 19 February 2015); Web of Science Conference Proceedings (1990 to 19 February 2015); ZETOC Conference Proceedings (1993 to 19 February 2015). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization's WHO International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language of publication or publication status in the searches of the electronic databases. Selection criteria: For caries data, we included only prospective studies with a concurrent control that compared at least two populations - one receiving fluoridated water and the other non-fluoridated water - with outcome(s) evaluated at at least two points in time. For the assessment of fluorosis, we included any type of study design, with concurrent control, that compared populations exposed to different water fluoride concentrations. We included populations of all ages that received fluoridated water (naturally or artificially fluoridated) or non-fluoridated water. Data collection and analysis: We used an adaptation of the Cochrane "Risk of bias" tool to assess risk of bias in the included studies. We included the following caries indices in the analyses: decayed, missing and filled teeth (dmft (deciduous dentition) and DMFT (permanent dentition)), and proportion caries free in both dentitions. For dmft and DMFT analyses we calculated the difference in mean change scores between the fluoridated and control groups. For the proportion caries free we calculated the difference in the proportion caries free between the fluoridated and control groups. For fluorosis data we calculated the log odds and presented them as probabilities for interpretation. Main results: A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis. The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1.81 (95% CI 1.31 to 2.31; 9 studies at high risk of bias, 44,268 participants) and in DMFT of 1.16 (95% CI 0.72 to 1.61; 10 studies at high risk of bias, 78,764 participants). This translates to a 35% reduction in dmft and a 26% reduction in DMFT compared to the median control group mean values. There were also increases in the percentage of caries free children of 15% (95% CI 11% to 19%; 10 studies, 39,966 participants) in deciduous dentition and 14% (95% CI 5% to 23%; 8 studies, 53,538 participants) in permanent dentition. The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste. There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels. There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels. No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria. With regard to dental fluorosis, we estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12% (95% CI 8% to 17%; 40 studies, 59,630 participants). This increases to 40% (95% CI 35% to 44%) when considering fluorosis of any level (detected under highly controlled, clinical conditions; 90 studies, 180,530 participants). Over 97% of the studies were at high risk of bias and there was substantial between-study variation. Authors' conclusions: There is very little contemporary evidence, meeting the review's inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries. The available data come predominantly from studies conducted prior to 1975, and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. The decision to implement a water fluoridation programme relies upon an understanding of the population's oral health behaviour (e.g., use of fluoride toothpaste), the availability and uptake of other caries prevention strategies, their diet and consumption of tap water, and the movement/migration of the population. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. We did not identify any evidence, meeting the review's inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults. There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes. There is a significant association between dental fluorosis (of aesthetic concern or all levels of dental fluorosis) and fluoride level. The evidence is limited due to high risk of bias within the studies and substantial between-study variation. [ABSTRACT FROM AUTHOR]

Background: Dental implants require sufficient bone to be adequately stabilized. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. Objectives: General objectives: To test the null hypothesis of no difference in the success, function, morbidity and patient satisfaction between different bone augmentation techniques for dental implant treatment. Specific objectives: (A) to test whether and when augmentation procedures are necessary; (B) to test which is the most effective augmentation technique for specific clinical indications. Trials were divided into three broad categories according to different indications for the bone augmentation techniques: (1) major vertical or horizontal bone augmentation or both; (2) implants placed in extraction sockets; (3) fenestrated implants. Search strategy: The Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 9 January 2008. Selection criteria: Randomized controlled trials (RCTs) of different techniques and materials for augmenting bone for implant treatment reporting the outcome of implant therapy at least to abutment connection. Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odd ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient. Main results: Seventeen RCTs out of 40 potentially eligible trials reporting the outcome of 455 patients were suitable for inclusion. Since different techniques were evaluated in different trials, no meta-analysis could be performed. Ten trials evaluated different techniques for vertical or horizontal bone augmentation or both. Four trials evaluated different techniques of bone grafting for implants placed in extraction sockets and three trials evaluated different techniques to treat bone dehiscence or fenestrations around implants. Authors’ conclusions: Major bone grafting procedures of resorbed mandibles may not be justified. Bone substitutes (Bio-Oss or Cerasorb) may replace autogenous bone for sinus lift procedures of atrophic maxillary sinuses. Various techniques can augment bone horizontally and vertically, but it is unclear which is the most efficient. It is unclear whether augmentation procedures at immediate single implants placed in fresh extraction sockets are needed, and which is the most effective augmentation procedure, however, sites treated with barrier plus Bio-Oss showed a higher position of the gingival margin when compared to sites treated with barriers alone. Non-resorbable barriers at fenestrated implants regenerated more bone than no barriers, however it remains unclear whether such bone is of benefit to the patient. It is unclear which is the most effective technique for augmenting bone around fenestrated implants. Bone morphogenetic proteins may enhance bone formation around implants grafted with Bio-Oss. Titanium may be preferable to resorbable screws to fixate onlay bone grafts. The use of particulate autogenous bone from intraoral locations, also taken with dedicated aspirators, might be associated with an increased risk of infective complications. These findings are based on few trials including few patients, sometimes having short follow up, and often being judged to be at high risk of bias. [ABSTRACT FROM AUTHOR]

Background: Prominent upper front teeth are an important and potentially harmful type of orthodontic problem. This condition develops when the child’s permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence. When treatment is provided during adolescence the orthodontist may provide treatment with various orthodontic braces, but there is currently little evidence of the relative effectiveness of the different braces that can be used. Objectives: To assess the effectiveness of orthodontic treatment for prominent upper front teeth, when this treatment is provided when the child is 7 to 9 years old or when they are in early adolescence or with different dental braces or both. Search strategy: The Cochrane Oral Health Group’s Trials Register, CENTRAL, MEDLINE and EMBASE were searched. The handsearching of the key international orthodontic journals was updated to December 2006. There were no restrictions in respect to language or status of publication. Date of most recent searches: February 2007. Selection criteria: Trials were selected if they met the following criteria: • design – randomized and controlled clinical trials; • participants – children or adolescents (age < 16 years) or both receiving orthodontic treatment to correct prominent upper front teeth; • interventions – active: any orthodontic brace or head-brace, control: no or delayed treatment or another active intervention; • primary outcomes – prominence of the upper front teeth, relationship between upper and lower jaws; • secondary outcomes: self esteem, any injury to the upper front teeth, jaw joint problems, patient satisfaction, number of attendances required to complete treatment. Data collection and analysis: Information regarding methods, participants, interventions, outcome measures and results were extracted independently and in duplicate by two review authors. The Cochrane Oral Health Group’s statistical guidelines were followed and mean differences were calculated using random-effects models. Potential sources of heterogeneity were examined. Main results: The search strategy identified 185 titles and abstracts. From this we obtained 105 full reports for the review. Eight trials, based on data from 592 patients who presented with Class II Division 1 malocclusion, were included in the review. Early treatment comparisons: Three trials, involving 432 participants, compared early treatment with a functional appliance with no treatment. There was a significant difference in final overjet of the treatment group compared with the control group of −4.04 mm (95% CI −7.47 to −0.6, chi squared 117.02, 2 df, P < 0.00001, I2 = 98.3%). There was a significant difference in ANB (−1.35 mm; 95% CI −2.57 to −0.14, chi squared 9.17, 2 df, P = 0.01, I2 = 78.2%) and change in ANB (−0.55; 95% CI −0.92 to −0.18, chi squared 5.71, 1 df, P = 0.06, I2 = 65.0%) between the treatment and control groups. The comparison of the effect of treatment with headgear versus untreated control revealed that there was a small but significant effect of headgear treatment on overjet of −1.07 (95% CI −1.63 to −0.51, chi squared 0.05, 1 df, P = 0.82, I2 = 0%). Similarly, headgear resulted in a significant reduction in final ANB of −0.72 (95% CI −1.18 to −0.27, chi squared 0.34, 1 df, P = 0.56, I2 = 0%). No significant differences, with respect to final overjet, ANB, or ANB change, were found between the effects of early treatment with headgear and the functional... [ABSTRACT FROM AUTHOR]