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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]

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.