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Aim To devise measurement instruments for ‘quality’ of root canal treatment to assess training and outcome of general dental practitioners working within primary care settings. Method Scoring systems relating to quality of root canal treatment were developed using expert consensus and published literature. Domains scored included the Treatment Process, Quality of the Obturation, Clinical Healing, Radiographic Healing and Tooth Complexity. Scoring systems were applied to 10 clinical cases treated by each dentist at the beginning and 10 cases treated at the end of their clinical training and 135 cases treated after completion of training. The dentists recorded the treatment process and clinical healing in clinical logs. Two examiners independently scored the radiographs after undertaking calibration and training. Inter- and intra-examiner reliability of scoring radiographic outcomes was tested using Cohen's Kappa statistics. Results An instrument was created with four domains to assess quality (two for process and two for outcome of root canal treatment), and a measure of case complexity. Domains of treatment process (n = 240 teeth), outcome (n = 32 teeth) and complexity (n = 215 teeth) were scored using radiographs. The Kappa scores for intra-examiner reliability between 0.22 and 1, whilst inter-examiner reliability ranged between 0.18 and 0.99. Conclusion Evidence-based scores for assessment of the quality (process and outcome) and complexity (structure) of root canal treatment were devised. They were reliable, provided that clinicians were trained in record keeping and examiners have in depth training and calibration in the use of the instruments. [ABSTRACT FROM AUTHOR]

When considering endodontically treated teeth, the quality of the restoration is important from the outset. It sheds light into possible causes of pulp necrosis or failure of endodontic treatment and influences the outcome of future endodontic treatment. A tooth undergoing endodontic treatment requires an effective coronal seal during and following completion of endodontic treatment. This paper discusses, using the available literature, the maintenance of optimal coronal seal and coronal integrity during and after root canal treatment. [ABSTRACT FROM AUTHOR]

Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard. [ABSTRACT FROM AUTHOR]

Objective There is a need to ascertain the use of evidence-based dentistry in both primary and secondary care in order to tailor education. This study aims to evaluate the use of 'open drainage' as part of endodontic treatment in primary care in South Yorkshire.Methods A questionnaire was circulated to 141 randomly selected general dental practitioners in the South Yorkshire area between January 2012 and January 2013.Results The response rate was 79% (112/141). Five of the returned questionnaires were incomplete and therefore not usable. Seventy-nine percent of respondents were general dental practitioners (GDPs) working in mainly NHS or mixed practices. The year of graduation varied between 1970 and 2011. Forty-one percent (44/107) stated that they had never left a tooth on open drainage. Twenty-nine percent (31/107) stated that they sometimes leave teeth on open drainage. Of those respondents who currently leave teeth on open drainage, most (68%) would leave teeth on open drainage for one to two days or less.Conclusions This survey revealed that the practice of leaving teeth on open drainage is still present in general dental practice. Current guidelines do not comment on the use of this treatment modality. There is a need to ascertain further information about practices throughout the United Kingdom in order to provide clear evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Localised anterior tooth wear can be managed using minimally invasive techniques with conservation of tooth structure and preservation of pulp vitality. This article describes and illustrates with two clinical cases, the management of localised tooth wear, with the restoration of canine guidance by a combination of gold palatal veneers and direct composite restorations. [ABSTRACT FROM AUTHOR]

Background The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided.Methods A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists.Results Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice.Conclusion This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed. [ABSTRACT FROM AUTHOR]

Introduction Locator retained implant overdentures are associated with a high incidence of prosthodontic complications. This study investigated whether general dental practitioners (GDPs) were willing to maintain these prostheses in primary dental care.Method A questionnaire was distributed to all GDPs referring patients for an implant assessment to the Charles Clifford Dental Hospital, Sheffield between 1 January 2012 and 30 June 2012.Results Ninety-four out of one hundred and forty-six questionnaires were returned (response rate: 64%). Thirteen GDPs (14%) were able to identify the Locator attachment system from clinical photographs. Eighty-two GDPs (87%) would adjust the fit surface of a Locator retained implant overdenture. Twenty-three GDPs (25%) would replace a retentive insert, 18 GDPs (19%) would tighten a loose abutment, 68 GDPs (72%) would debride abutments and 25 GDPs (27%) would remake a Locator-retained implant overdenture. Forty-seven GDPs (50%) felt that the maintenance of these prostheses was not their responsibility. The main barriers identified to maintenance by GDPs were a lack of training, knowledge and equipment. Seventy GDPs (74%) would like further training in this area.Conclusions GDPs are not familiar with the Locator attachment system and are reluctant to maintain implant retained overdentures. GDPs would like further training in this area. [ABSTRACT FROM AUTHOR]

Introduction: Teenage pregnancy is common and has become a key public health concern for all. This study aims to discover the meaning of lived experiences and to strategize in addressing the phenomenon from the previous or current unwed pregnant girls' or young women's perspective. Methods: A qualitative study was conducted among 10 girls or young women recruited during their stay at two shelters in Selangor but came from various state in Malaysia; who have experienced becoming unwed mothers when they were between 10 to 19 years old. All participants gave informed consent. In-depth face-to-face interviews were conducted, audiotaped and transcribed. All quotes were encoded using Qualitative Data Analysis (QDA) Miner program. Data were analyzed using interpretative phenomenological analysis. Results: The themes emerged from the analyses; i) Trajectory of sexual activity, ii) struggles of motherhood to un-wed teenage mother. Most of these girls were pregnant due to consensual sexual intercourse although there were some refutes but their actions have led them for this to happen. They described how indirect relationship such as communication via telephone and the internet may have initiated the desire for sexual activity which led to a short first-time meeting and short term partnership, caused them to enact the sinful deed. They were overwhelmed with ambivalence feelings of wanting to terminate the pregnancy, abandon the newborn or to endure the journey of motherhood together with their ex-nuptial baby. Conclusion: The findings of this study showed that the strength of indirect relationship is able to evoke sexual desire that contributes to out-of-wedlock pregnancy. Maximum support is needed from all; peers, parents, educators and the whole community structures. [ABSTRACT FROM AUTHOR]

Study Objective: To assess the impact of a personalized integrative medicine (IM) intervention on healthcare providers (HCPs) expressing war-related emotional/spiritual and physical concerns., Methods: Physicians, nurses, para-medical and other HCPs from 5 hospital departments in northern Israel underwent IM treatments provided by IM-trained practitioners working in integrative oncology (IO) care settings. The two main HCP-reported concerns were scored (from 0 to 6) before and following the intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Post-intervention narratives were examined for emotional/spiritual keywords (ESKs)., Results: Of 190 participating HCPs, 121 (63.7%) expressed ESKs in post-treatment narratives (ESK group), with 69 not expressing ESKs (nESK group). Both groups had similar demographic and professional backgrounds, and reported improved measure yourself concerns and well-being (MYCAW) QoL-related concerns immediately post-intervention. However, between-group analysis found significantly greater improvement in the ESK group for the first (p < 0.001) and second (p = 0.01) MYCAW concerns, as well as emotional/spiritual concerns (p < 0.001). Pain-related concerns improved similarly in both groups, with improved scores continuing to 24-h post-treatment., Conclusions: HCPs with war-related emotional/spiritual and physical QoL-related concerns showed significant improvement following the IM intervention. This was more significant among those reporting ESKs for their two major and emotional/spiritual concerns, with pain scores improving similarly in both groups. Future research needs to explore specific and non-specific effects of IM intervention provided by IO practitioners working outside their "comfort zone", fostering collaboration between IM and mental health providers to address HCP wellbeing and resilience during a time of national crisis., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Aim: This paper aims to assess the complexity, quality and outcome of endodontic treatment provided in Managed Clinical Networks (MCNs) in England to understand if we are "getting it right first time" (GIRFT)., Methods: In a convenient sample of endodontic treatments provided between May 2011 and April 2017, the complexity of teeth treated, the quality of treatment procedure, the radiographic appearance of root fillings, as well as clinical and radiographic healing were retrospectively assessed using records taken as part of treatment. Trained, calibrated examiners independently scored radiographs using previously published scoring systems., Results: 646 teeth were followed up for 24.7 months (standard deviation [SD] 17.08). The average age of those patients treated was 46.7 years (SD 15.38) with 48.3% being male. Of teeth treated, 70.4% were of complexity level 3. 88.2% of teeth were asymptomatic, and 80% demonstrated complete radiographic healing. Procedural errors inhibited achieving correct working length and taper, with more voids within root canal fillings. When patency filing was reported as being carried out, complete radiographic healing was more likely., Conclusions: It is possible to collate outcome data in the NHS system, especially if there is provision for ongoing follow up and time allocated for collection of data. Endodontic treatment provided within primary and secondary care settings are of high quality, with outcomes being better with single operators carrying out high volumes of endodontic treatment., Competing Interests: Declaration of conflict of interestMost of the authors (S. Eliyas, K. Shah, N. Dhamecha, A. Yusuf, V. Jasani and T. Jayaram) were involved in treating some of the patients in the audit, however all data were anonymised and randomised to eliminate bias.S. Eliyas taught on the DES course in 2009–2011, described in this article.A. Yusuf, V. Jasani and T. Jayaram were delegates taught in the DES course in 2009–2011.The other authors have stated explicitly that there are no conflicts of interest in connection with this article.

Background: We wanted to assess the effect of life skills education (LSE) and regular curriculum on the self-esteem, self-efficacy, adjustment, and psychosocial functioning of students from co-educational government schools, compared to those receiving only the regular curriculum. The secondary objectives were to study the feasibility of such sessions and identify the factors affecting the effectiveness of the sessions., Materials and Methods: We conducted a mixed-methods study in government schools of urban Puducherry, India in 2018-2019. The quantitative component was a cluster-randomized trial with activity-based learning methods delivered over 10 sessions in the intervention arm (IA). Differences in outcome variables (self-esteem, self-efficacy, adjustment, psychosocial behavior) between baseline and after intervention in each of the groups were calculated, and the difference-in-differences (DID) technique was applied to account for any natural change in scores over time. Qualitative data were collected through focused group discussions (FGDs) among students and teachers. Analysis was founded on a positivist paradigm with inducto-deductive methodology., Results: The mean (SD) age of 258 participants was 13 (1) years in both arms. The mean (SD) difference between baseline and end-line for IA and control arm (CA) was 0.3 (4.4) and - 0.1 (4.0), for self-esteem ( P = 0.38), 0.03 (6.0) and - 1.1 (6.1) for self-efficacy ( P = 0.12), and - 0.04 (3.5) and - 0.05 (4.3) for adjustment ( P = 0.73), respectively. Similarly, the median (interquartile range [IQR]) difference in the conduct problems scale of the Strengths and Difficulties Questionnaire was - 1 (-2, 1) and 0 (-1, 1) ( P < 0.01). Five FGDs revealed multiple positive effects on anger management, conduct, self-awareness, and responsible behavior. All 10 teachers viewed life skills education (LSE) positively., Conclusions: LSE positively affects adolescents' socio-emotional functioning, but more extended periods of exposure are needed to demonstrate discernible change. The feasibility of implementation depends on the syllabus and based on health policies., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background and Aims: Posterior lumbar spine fusion surgeries are associated with severe postoperative pain necessitating a multimodal analgesic regime. Wound infiltration with local anaesthetic is an accepted modality for postoperative analgesia in spine surgeries. Thoracolumbar interfascial plane (TLIP) block is a novel technique being evaluated for providing analgesia in lumbar spine surgeries. This study aimed to compare the analgesic efficacy of TLIP block compared to that of wound infiltration with local anaesthetic in terms of time to request the first dose of rescue analgesic., Methods: Seventy-one patients scheduled for posterior lumbar spine fusion under general anaesthesia were included in this double-blinded randomised controlled trial. Preoperatively, patients were randomly allocated to receive either a TLIP block (TLIP group) or wound infiltration (LI group). The primary endpoint was the time of the first request for rescue analgesia. Secondary endpoints were the total tramadol consumption and pain and comfort scores measured at various time points in the 48-h postoperative period. The trial was terminated after second interim analysis as the analgesic benefit of TLIP was evident both clinically and statistically., Results: The median (interquartile range) duration of the time of the first request for rescue analgesia was 1440 (1290, 2280) min in the TLIP group and 340 (180, 360) min in the infiltration group; P value <.001. The mean tramadol consumption was significantly higher in the infiltration group compared to the TLIP group, with a P value <.001., Conclusion: TLIP block provided better postoperative analgesia than that provided by wound infiltration with local anaesthetic., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Anaesthesia.)

Background According to the Children's Dental Health Survey 2013, around one in ten children in Wales, Northern Ireland and England will have sustained dental trauma to a permanent incisor by the of age 15. Management of an exposed pulp in an immature permanent incisor is often urgent and has an impact on the long-term outcome of the tooth; therefore, it is essential that general dental practitioners feel confident in managing such a scenario to achieve an optimal outcome. This paper discusses the indications, technique, materials and outcomes.Aims This article aims to review the literature, which discusses various treatment modalities and materials for pulpal therapy and root canal treatment in the immature permanent tooth.Method Electronic searches were limited to English language, human studies, published within the past five years and the medical subject heading terms used were: direct pulp capping, apexogenesis, Cvek pulpotomy, full pulpotomy/pulpectomy, partial pulpotomy, apexification, non-vital pulp therapy and mineral trioxide aggregate apexification. Older, seminal articles identified through the references sections have also been included.Conclusion A number of options are available for the management of immature permanent teeth that have suffered an insult such as caries or trauma. This paper reviews the various methods of pulpal treatment, preservation therapy and root canal treatment options depending on the extent of the damage., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

With increasing medical complexity of patients, including the widespread use of bisphosphonates and the increased incidence in head and neck cancer diagnosis, there are ever more difficult decisions to be made within restorative dentistry. The most morbid dental complication to avoid with both the use of bisphosphonate and radiotherapy to the jaws is necrosis of the jaws, ideally by avoiding dental extractions, usually for the entirety of the patient's lifetime. If these patients undergo a dental assessment before commencing such medical treatments, there is a window of opportunity for both dental extractions of teeth with a poor/hopeless prognosis and for appropriate emphasis on prevention. Treatment planning at this stage has the goal of avoiding further dental extractions completely in the future. However, not all patients have an ideal care pathway. This article describes a case with an impossible choice to be made with significant time pressure and during the most vulnerable of times in a patient's life. The short-, medium- and long-term challenges posed are discussed.

Competing Interests: There are no conflicts of interest.

In 2019, in a world of instant gratification, what are the expectations of patients and dentists? Is training sufficient to meet these expectations? Decision-making in dentistry impacts the treatment choices patients are given, and may influence the outcomes of such treatment. It is therefore important to ensure as much standardisation as possible. In order to achieve this, it is important to know the current standard and the views of dentist as this will influence dental treatment planning. Clinical Relevance: This paper captures the treatment planning dilemmas of dentists, specifically of those in their Foundation training year, in order to aid targeting of training and development. Objective Statement: To understand treatment decisions of general dental practitioners and specialists.

The intended outcome of dental education is to produce dental clinicians who have the knowledge, technical skills, personal attributes, values and professional outlook to deliver the highest level of patient care. Due to the development and improvement of dental materials and clinical techniques, combined with a steady rise in patient expectations and complaints, prosthodontics has developed into a dental speciality recognised by the General Dental Council. Going forward, there will be a requirement to provide complex and difficult operative and prosthodontic dentistry. Much will be replacement and repair of existing failing work, with the application and choice of newer materials and clinical approaches. How does the dental education sector respond to this challenge? This article attempts to discuss potential solutions for training and education, for all levels of prosthodontics in the UK.

In order to best use available resources, the dental workforce needs to be sufficiently skilled to provide the correct treatment in the right place in the patient pathway, without need for escalation to secondary care. Education is a means to improve quality of healthcare with significance being placed on the proficiency of teaching and effectiveness of learning. The aim is to make the most efficient use of resources to upskill the existing workforce without significant reduction in the services that can be provided during training. With increasing academic demands on the undergraduate curriculum, there may be an expectation that general dental practitioners involved in vocational training now have a larger role to play in providing clinical training for the graduating dentists of the future. With this in mind, this article provides a narrative overview of the concepts to be considered in dental education and training. More education and training activities may be expected to take place in the workplace; therefore general dental practitioners may be at the forefront of providing high quality practice-based dental education and training in the future.

The use of antibiotic prophylaxis to reduce the risk of infective endocarditis (IE) in susceptible individuals is a topic which has historically prompted many controversial debates. In the past, dentists have been understandably unwilling to prescribe antibiotic prophylaxis for fear of deviating from the National Institute for Health and Care Excellence (NICE) guidelines. However, in 2016, NICE altered the wording of these guidelines. The subtle change in wording implied that the clinician could use their clinical judgement, alongside advice from cardiologists, to deem their patient high-risk enough to prescribe antibiotics. In this article we discuss the implications of the NICE guidelines, and present the case of a patient who historically received antibiotic prophylaxis due to a history of rheumatic fever. Following the old NICE guidelines of 2008 he no longer received this prescription. As a consequence, he went on to suffer from IE from an unexpected cause due to ineffective preventative advice.

Aims: To explore the impact of dedicated training to extend the skills of primary care practitioners on the quality of endodontic care, using clinical, radiographic and patient-related outcomes., Methods: The quality of endodontic treatment performed at the beginning and end of training to become dentists with extended skills (DES) in endodontics was assessed in vitro and in vivo from endo-training blocks and self-reported logbooks containing clinical notes and radiographs respectively. The quality of endodontic care delivered by DES post-training was measured using clinical and radiographic outcomes. Patient-related outcomes were assessed using a self-report questionnaire, including the Oral Health Impact Profile – Endodontic Outcome Measure (OHIP-EOM)., Results: Data on eight dentists were examined pre-and post-training, five of whom participated in further follow-up investigations on the quality of endodontic care delivered to their patients. Significant improvements in skills were seen for all domains in vitro (p <0.05), and for all domains of the clinical treatment process, and achieving the correct working length of the root filling as seen by radiography in vivo (p <0.05). The quality of the clinical process was maintained following training. Positive patient outcome (OHIP-EOM) scores were recorded (mean score of 34.72, SD = 10.74, n = 120 pre-treatment and 25.85, SD = 7.74, n = 47 representing reduced impact at follow-up). The majority of patients reported being satisfied, or very satisfied, with the service they received (72.5%, n = 98); would use the service again (68.1%, n = 92); and would recommend the service to friends and family (74.8%, n = 101)., Conclusions: Findings suggest that training for dentists working in practice can be successful in enhancing skills and changing practice, with evidence of high patient satisfaction and good clinical and patient-related outcomes. Pilot results must be interpreted with caution and further research is required.

Objectives: To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs., Methods: Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training., Participant: Dentists working in and patients treated in primary dental care in London., Intervention: Twenty-four-month training in endodontics., Comparison: Dentists enrolled in the training at different time points., Outcome: Measuring outcome of endodontic treatment., Results: Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1–36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up., Conclusions: Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.

Objective To explore the experiences of primary care dentists following training to enhance endodontic skills and their views on the implications for the NHS.Design Qualitative study using anonymised free text questionnaires.Setting Primary care general dental services within the National Health Service (NHS) in London, United Kingdom.Subjects and methods Eight primary care dentists who completed this training were asked about factors affecting participant experience of the course, perceived impact on themselves, their organisation, their patients and barriers/facilitators to providing endodontic treatment in NHS primary care. Data were transferred verbatim to a spreadsheet and thematically analysed.Intervention 24-month part-time educational and service initiative to provide endodontics within the NHS, using a combination of training in simulation lab and treatment of patients in primary care.Results Positive impacts were identified at individual (gains in knowledge, skills, confidence, personal development), patient (more teeth saved, quality of care improved) and system levels (access, value for money). Suggested developments for future courses included more case discussions, teaching of practical skills earlier in the course and refinement of the triaging processes. Barriers to using the acquired skills in providing endodontic treatment in primary care within the NHS were perceived to be resources (remuneration, time, skills) and accountability. Facilitators included appropriately remunerated contracts, necessary equipment and time.Conclusion This novel pilot training programme in endodontics combining general practice experience with education/training, hands-on experience and a portfolio was perceived by participants as beneficial for extending skills and service innovation in primary dental care. The findings provide insight into primary dental care practitioners' experience with education/training and have implications for future educational initiatives in support of systems innovation within the NHS.

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in U.K. general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools. CPD/CLINICAL RELEVANCE: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.

Decision-making is a fundamental aspect of clinical dentistry. Advances in technology and trends towards more conservative technologies have broadened the options available to patients and dentists, increasing the range of choices and opportunities to restore teeth. With such a broad range of dental materials, there are a number of factors to consider in making an appropriate choice. We present several decision-making dilemmas. Namely; how to restore worn lower anterior teeth, what to consider when replacing crowns, materials to consider when providing cuspal protection for posterior teeth, and finally the issues to consider when selecting a luting cement. The evidence supporting different clinical choices is considered in a discussion of the various dilemmas faced.

Unlabelled: Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear., Clinical Relevance: With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.

Cancer care has become one of the main targets of the National Health Service in England and with cancer patients surviving longer, it is likely that head and neck cancer patients will make up a large proportion of patients seen within secondary care settings in the future. The management of these patients can be very difficult for a number of reasons. Part one of this paper attempts to highlight the major oral health problems encountered by these patients during and after their cancer treatment and supported by the current literature. Part two of this series will address the dental management of head and neck oncology patients undergoing radiotherapy with particular attention of possible improvement to current management strategies for these patients.

Dental maintenance and rehabilitation of head and neck cancer care is becoming more important as the outcome of cancer treatment improves. The management of these patients can be very difficult for a number of reasons as discussed in part one of this two-part series. This second part attempts to suggest possible solutions for the management of the major oral health problems encountered by these patients during and after their cancer treatment.

Background: Radiotherapy as part of head and neck cancer treatment leaves patients requiring much dental rehabilitation in a compromised environment that is difficult for the patient and the dental team to manage., Objectives: To assess the effects of maintaining the patient's natural dentition during radiotherapy in comparison to extracting teeth before radiotherapy in areas that are difficult to access by the patient and the dentist, should reduction in mouth opening occur after radiotherapy to the jaws., Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 22 November 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11), MEDLINE via OVID (1946 to 22 November 2012), EMBASE via OVID (1980 to 22 November 2012), CANCERLIT via PubMed (1950 to 22 November 2012), CINAHL via EBSCO (1980 to 22 November 2012) and reference lists of articles. We advertised for currently ongoing studies via the Cochrane Oral Health Group website and the Cochrane Oral Health Group Twitter feed. , Selection Criteria: Randomised controlled trials comparing extraction of teeth prior to radiotherapy with leaving teeth in situ during radiotherapy to the jaws., Data Collection and Analysis: Three review authors independently assessed the results of the searches for inclusion in the review. , Main Results: No randomised controlled trials were found., Authors' Conclusions: There are no randomised controlled trials to assess the effect of extracting teeth prior to radiotherapy compared to leaving teeth in the mouth during radiotherapy to the jaws.

This paper highlights the importance of root canal disinfection. It discusses the different endodontic irrigants available and comments on how these can be used most effectively.

This second article will concentrate on the clinical use of root canal irrigants, highlighting why commonly used techniques may be suboptimal and result in ineffective disinfection during endodontic therapy.

Unlabelled: This paper highlights the importance of root canal disinfection. It discusses the different endodontic irrigants available and comments on how these can be used most effectively., Clinical Relevance: Eliminating bacteria from the root canal system is an essential stage in endodontic therapy. Practitioners should be adequately informed and skilled in this vital aspect of endodontics.

Data Sources: The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were searched. Handsearching included several dental journals. Authors of all identified trials, an internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCT)., Study Selection: All RCT of root-form osseo-integrated dental implants comparing various techniques to handle soft tissues when placing dental implants were included. Outcome measures considered were: prosthetic and implant failures, aesthetics evaluated by patients and dentists, biological complications, postoperative pain, patient preference, ease of maintenance by patient, and width of the attached or keratinised mucosa., Data Extraction and Synthesis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Authors were contacted for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes, and risk ratios for dichotomous outcomes, with 95% confidence intervals. Heterogeneity was to be investigated, including both clinical and methodological factors., Results: Eight RCT were identified and five trials, which included 140 patients in total, were selected. Two trials (comprising 100 patients) compared flapless placement of dental implants with conventional flap elevation, two trials (20 patients) crestal versus vestibular incisions. On a patient (rather than per-implant) basis, implants placed with a flapless technique and implant exposures performed with a laser induced significantly less postoperative pain than flap elevation. There were no statistically significant differences for any of the other analyses., Conclusions: Flapless implant placement is feasible and has been shown to reduce patient postoperative discomfort in appropriately selected patients. Sufficient, reliable evidence is not available for recommendations to be made about which techniques or materials for incision or suture are most beneficial to patients. This is also the case for techniques to correct or augment perimplant soft tissues or to increase the width of keratinised or attached mucosa. Properly designed and conducted RCT are needed to provide reliable answers to these questions.

Data Sources: The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, Medline and Embase were searched. Handsearching included several dental journals. Authors of all identified trials, an internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCT)., Study Selection: RCT were selected of root-form osseo-integrated oral implants that had a followup of 6 months-1 year and which compared the same osseo-integrated root-form implants immediately (within 1 week), early (1 week-2 months) and conventionally loaded (after 2 months), giving the following outcome measures: failures, implant failures and marginal bone levels on intra-oral radiographs., Data Extraction and Synthesis: Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed., Results: Twenty RCT were identified and 11 trials comprising a total of 300 patients were included. Six trials compared immediate versus conventional loading, three early versus conventional loading and two immediate versus early loading. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses., Conclusions: It is possible to successfully load dental implants immediately or early after their placement in selected patients, but not all clinicians achieve optimal results when loading the implant immediately. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/ early loading procedure. More well-designed RCT are needed. Priority should be given to trials comparing immediately versus early loaded implants to improve patient satisfaction and decrease treatment time and trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/).