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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 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]

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]

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: 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]

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]

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]

A proprietary calcium hydroxide paste, Reogan Rapid, that previously has been demonstrated to induce apical closure in non-vital immature incisor teeth, was becoming unavailable. A prospective clinical trial was conducted to compare Reogan Rapid with another proprietary paste, Hypo-cal. For teeth treated with Reogan Rapid apical closure was obtained in an average of 6.8 months involving 3.1 visits and the respective figures for teeth treated with Hypo-cal were 5. 1 months and 2.4 visits. These results demonstrated that Hypo-cal was as effective as Reogan Rapid when used in a standardised technique for inducing apical closure. [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]