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To investigate the potential mineralising effects of calcium silicate-based dentine replacement material (Biodentine™) in comparison with glass-ionomer cement (GIC) (Fuji IX™) on different human dentine substrates using a multimodal non-invasive optical assessment.Cements were applied on artificially demineralised or naturally carious dentine and stored for 4 weeks in phosphate-rich media +/- tetracycline used for mineralisation labelling. Interfacial dentine was examined from the same sample and location before and after aging using two-photon fluorescence microscopy, fluorescence lifetime imaging (FLIM) and second harmonic generation (SHG) imaging. Additionally, Raman spectroscopy was used to detect changes in the mineral content of dentine.Significant changes in the fluorescence intensity and lifetime were detected in partially demineralised dentine and caries-affected dentine underneath both tested cements, after storage (p 0.001). This was associated with a significant increase in the mineral content as indicated by the increased intensity of the phosphate Raman peak located at 959 cm

Objective: To determine the psychometric properties of a pre-existing orthodontic satisfaction questionnaire and to assess patient satisfaction of their orthodontic treatment. Design: Psychometric assessment of a pre-existing orthodontic satisfaction questionnaire. Setting: Two sites at King’s College Hospital NHS Foundation Trust. Participants: Individuals aged 12–15 years who had completed fixed orthodontic treatment. Methods: An expert panel assessed a pre-existing orthodontic treatment satisfaction questionnaire for validity and readability. As a result, revisions were made to the questionnaire and it was distributed to 103 participants aged 12–15 years, on completion of their fixed orthodontic treatment (T1). Test–retest reliability of the questionnaire was assessed through completion of a second questionnaire by 17 participants, at a two-week interval (T2). The questionnaire was assessed for reliability using item-total correlations (I-TC) and Cronbach’s alpha. Factor analysis allowed exploration of the underlying factor structure of the questionnaire. Test–retest reliability was assessed using Cohen’s kappa coefficient. Multiple regression analysis was used to find out the significant demographic variables that predicts the satisfaction level of treatment. Results: Following validity and readability assessment by the expert panel, the questionnaire was revised. Eleven items were removed following item analysis (with I-TC ⩽ 0.3). Factor analysis was deemed uninterpretable. The overall scale demonstrated greater reliability than the underlying sub-scales. Therefore, the sub-scales were removed, resulting in one scale which assessed overall orthodontic satisfaction, comprising 37 items, with a Cronbach alpha of 0.92. The test–retest reliability of the revised 37-item scale was deemed to be poor (kappa coefficient = 0.39). Multiple regression analysis identified ethnicity as a significant predictor of orthodontic treatment satisfaction ( P = 0.01). Conclusion: This study provides a valid measure to assess orthodontic treatment satisfaction for use in a UK population aged 12–15 years on completion of fixed orthodontic treatment.

This observational study compared palatal rugae morphology in adolescent subjects with normal tooth number and tooth agenesis. Maxillary dental study casts were used to compare rugae number, length and shape. Each study group contained 60 subjects (30 females and 30 males) mean age 13.4 (SD, 1.55) in control and 13.56 (SD, 1.54) years in tooth agenesis groups (p = 0.576). Mean number of missing tooth units in the tooth agenesis group was 2.1. Mean number of primary rugae in the whole sample was 4.35 (SD, 0.98) on the right and 4.33 (SD, 0.92) on the left with no significant differences (p = 0.236 and p = 0.404, respectively). However, the number of secondary rugae on the left (p = 0.006) and fragmentary rugae on the right (p = 0.004) was significantly increased in the tooth agenesis group. The shape of left primary rugae 2 and 3 also differed between groups, tending towards a wavy pattern in the control group and curved in the tooth agenesis group (p = 0.012 and p = 0.004, respectively). In addition, primary rugae 3 was more convergent (p = 0.008) whilst left primary rugae 3 and 5 were orientated in an antero-posterior direction (p = 0.04 for both rugae) in the tooth agenesis group. Subgroup analysis also identified significant associations between patterns of tooth agenesis and rugae number, in addition to shape of primary rugae. The identification of significant differences in rugae pattern between subjects with normal tooth number and agenesis suggests potential commonality in signal pathway disruption during establishment of these structures.

Summary Introduction The purpose of this retrospective study was to evaluate 34 years’ experience of autotransplantation of teeth during orthodontic treatment. Methodology Treatment was completed at Queen Mary’s Hospital, Sidcup, Kent, UK, during the period 1969–2003. A total of 366 teeth were transplanted in 314 patients. Results Canines totalled 78 per cent of all autotransplanted teeth; mean age of patient was 19.4 years. Survival probability for the first 5 years post-autotransplantation was 95 per cent, 94 per cent for the subsequent 5 years, and 88 per cent after 15 years. The maximum observation period was 34 years, the median was 2.0 years, and the mean was 3.51 (standard deviation = 3.68) years. Of the observed teeth, 10 failed and these were lost due to unsuccessful periodontal ligament regeneration and persistent mobility grade III (or greater). Apical pathology was observed in 16 per cent of all autotransplanted teeth. In 79 per cent of this subgroup, apical pathology was evident in the first 3 years post-operatively. Seventy per cent of all external resorption also occurred within the first 3 years. Internal resorption was rare but its occurrence was mostly observed between the second and sixth year post-transplantation. A minority of autotransplanted teeth [14 per cent (n = 51)] needed root canal therapy, and this was completed within the first 6 months post-transplantation. Conclusions Autotransplantation can be a justified procedure with good survival probability. It can be considered an alternative to other treatments, such as prosthodontic replacement of teeth.

The expression of uncertainty is defined by the standard deviation and is usually expressed in multiples of the standard deviation (±1sd, ±2sd, and ±3sd). The objective was to use weighting of the sd calculation by the number or count of subjects for each tooth development stage. A comparison shows the difference between the range of uncertainty using the unweighted sd and the weighted sd. The range of uncertainty related to Dental Age Estimation is statistically significantly greater (p < 0.001) for the weighted sd compared to the unweighted sd. It is concluded that the number of subjects for each Tooth Development Stage in the Reference Data set should be included in the calculation for a single Dental Age Estimation using the Simple Average Method when presenting the uncertainty associated with the point estimate of the "mean" for Dental Age Estimation of a single subject of unknown age.

Introduction A high percentage of people with dental phobia have poor oral health. This may be the result of delayed treatment or differences in care planning by the oral health care team.Aim This study sought to determine the effect, if any, of dental phobia and complexity of dental care on the proposed care plan devised by clinicians for patients.Design An experimental analogue study with independent variables of the presence of phobia and complexity of treatment need. Dependent variables included frequency of care planning elements such as periodontal treatment, prevention, restorations, root canal treatment, extraction and provision of crowns, bridges and prostheses.Participants Seventy-nine UK-based dental practitioners.Analysis The association between the case status (phobic versus non-phobic, simple versus complex) and the outcome variables were assessed using a chi-square test for association. Logistic regression analyses were also used to determine the predictors of care planning elements.Results There were no differences in care planning for phobic and non-phobic patients. Complexity of treatment need had significant effects on advanced periodontal treatment, restorations anterior and posterior, root canal treatment, provision of crowns, and extractions.Conclusions Care planning is influenced by patients' dental needs and not their phobic status.

Introduction: The objective of this randomised controlled trial (RCT) is to investigate the effect of a social networking site (SNS) on body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy, and whether these effects differ from the use of appearance-neutral Instagram images. We also aimed to investigate whether there are trends in increased self-reported use of social media and increased body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy. Methods: Undergraduate students were randomly allocated to an experimental group with idealised smile images or to a control group with neutral nature images. They completed pre-exposure questionnaires, then perused for 5 min their allocated images on individual Apple iPads via the Instagram application. Participants then completed the post-exposure surveys. The main outcome was facial dissatisfaction. Body dissatisfaction and total facial and body dissatisfaction were secondary outcomes. Simple randomisation was achieved with a computerised random number generator. Data were analysed using repeated measures ANOVA and multivariate regression analyses. Results: A total of 132 participants (mean age = 20.50 ± 2.21 years) were randomised to either the experimental group with idealised smile images (n=71) or the control group with neutral nature images (n=61). Baseline characteristics were similar between groups and no participants were lost. Exposure to ‘ideal’ facial images on social media decreases facial satisfaction (95% confidence interval [CI] = 0.85–1.05; P < 0.0001). Individuals with high baseline self-discrepancy scores are less satisfied with their facial features and body appearance (95% CI = 0.04–1.16; P = 0.036). Conclusion: This study shows that viewing SNSs with high visual media reduces satisfaction with facial appearance in the short term in men and women. This effect is greater in those with high self-discrepancy scores. Increased media usage was not correlated with increased dissatisfaction. Wearing braces or having had braces was shown not to influence post-exposure dissatisfaction.

Contains fulltext : 225280.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The aim of this systematic review was to assess intervention rates of direct composite restorations in the worn dentition based on data published in clinical trials. METHODS: Searches of electronic data bases, grey Literature and hand searches were completed, and selection criteria were applied at the title, abstract and full paper stages. Unavailable full papers or papers with unsuitable data were excluded. A reference search was conducted, and a final set of papers were selected for data analysis. Data were extracted and noted as any intervention required or performed, or intervention free. Descriptive statistics were used to summarise the findings and the odds ratios were calculated. RESULTS: 1683 titles were found in the initial searches. On application of selection criteria, 140 abstracts were selected (Kappa 0.885), 17 papers were chosen by 3 reviewers (Kappa 0.914 - 0.942) and 12 selected for statistical analysis (Kappa 0.924). A total of 3540 composites in 386 participants were analysed, with 1919 in the anterior region, and 1044 in the posterior region of these 11.7 % required intervention. Annual Intervention Rates (AIR) ranged from 0.8 to 17.9% reflecting the variation in reporting. CONCLUSION: There was wide variation between studies on the type of intervention. Overall the intervention rate of 11.6 % shows a favourable outcome but suggests some form intervention may be needed. CLINICAL SIGNIFICANCE: Direct composites remain a viable option to treat tooth wear but the outcome varies. Provided patients appreciate that some maintenance may be needed they are an effective intervention.

Statement of problem Indirect restorations are an important treatment in dental practice, but long-term survival studies are lacking. Purpose The purpose of this retrospective study was to report on the outcome of indirect restorations, which were followed up annually for up to 50 years in a dental practice. Material and methods A retrospective survival study was undertaken at a mixed National Health Service (NHS)/private dental practice in London, UK. Data were collected for restorations placed between 1966 and 1996 by 1 experienced operator. It was a requirement that patients had been followed up annually with clinical and radiographic examinations for up to 50 years. Patients were enrolled on a strict preventive policy and had excellent oral hygiene. Oral hygiene, restoration location, sensitivity, occlusion, and other details (preparation design, taper, cement used) were recorded. Restoration outcome was recorded as successful and surviving, unknown, or failed. The data were described descriptively. Kaplan-Meier survival curves and hazard curves were used to assess the survival of crowns and the probability of failure over time. Results A total of 223 restorations were placed in 47 patients between 1966 and 1996 and reviewed annually for up to 50 years (until 2016). These restorations included 154 metal-ceramic crowns (101 posterior and 53 anterior), 25 posterior gold crowns, 22 anterior ceramic veneers, and 22 anterior ceramic crowns. Restorations were in occlusion. The mean survival for metal-ceramic crowns was estimated as 47.53 years (95% confidence interval [CI]: 45.59-49.47 years). Failures in metal-ceramic crowns (n=6, 3.9%) were due to periapical periodontitis. The remaining restoration types had 100% survival at 50 years. Conclusions This study showed that the survival of crowns and veneers is high over 50 years in clinical practice with annual follow-up and good oral hygiene. The proportion of teeth with loss of vitality, confirmed clinically and with radiographs, was minimal.

Aim: The aim of this study is to explore the prognostic significance and clinicopathological correlations of the Wnt pathway genes in a cohort of surgically treated patients with oral squamous cell carcinoma (OSCC) patients. Settings and Design: A prospective genetic study on patients with OSCC was carried out during the period from July 2014 to January 2016. Informed consent from patients and institutional ethical approval for the study was obtained and the guidelines were strictly followed for collection of samples. Subjects and Methods: Clinical data and mRNA expression analysis of ten genes in the canonical Wnt pathway were evaluated and their relationships with clinical and demographic variables were studied in 58 tissue samples. Wnt-3a, β-catenin, secreted frizzled-related proteins sFRP-1, sFRP-2, sFRP-4, sFRP-5, Wnt inhibitory factor 1, dickkopf-1, c-MYC, and cyclin-D1 from cancer (n = 29) and normal (n = 29) tissue samples were investigated using quantitative reverse transcription-polymerase chain reaction. Statistical Analysis: Descriptive statistics were used to summarize the sample characteristics and clinical variables. If the data were normal, then parametric tests were used; otherwise, nonparametric alternatives were used. All the analyses were carried out using SPSS version 23.0 (IBM SPSS Inc., USA). Results: Expression of sFRP-1, sFRP-2, and sFRP-5 in control samples and expression of c-MYC and cyclin D1 in cancer samples showed statistical significance. Significant expression of Wnt3A was observed among patients who had recurrence and were deceased. Conclusion: Wnt3A, β-catenin, and cyclin D1 are recognized as key components of Wnt/β-catenin signaling. However, in this study, there was no significant expression of all the three genes in OSCC. The proto-oncogene c-MYC showed statistically significant upregulation in cancer tissue samples suggesting that the OSCC among South Indian population is primarily not mediated by the canonical Wnt signaling pathway.

Background: Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and documentation at each visit. Objectives: The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter- and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA). Methods: Fifteen patients with mild-to-moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h. Results: In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0·97, MMPDAI activity 0·59 and damage 0·15, ABSIS total 0·84, and PGA 0·72. The intraobserver ICCs (two observers) for ODSS total were 0·97 and 0·93; for MMPDAI activity 0·93 and 0·70 and damage 0·93 and 0·79; for ABSIS total 0·99 and 0·94; and for PGA 0·92 and 0·94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0·88). The mean ± SD time for completion of ODSS was 93 ± 31 s, with MMPDAI 102 ± 24 s and ABSIS involvement 71 ± 18 s. The PGA took < 5 s. Conclusions: This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform. What's already known about this topic?. There are no validated scoring methodologies for oral mucous membrane pemphigoid (MMP). Proposed disease activity scoring tools for MMP include the Mucous Membrane Disease Area Index (MMPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). The Oral Disease Severity Score (ODSS) has been validated for use in oral pemphigus vulgaris (PV). It has been shown to be reliable and sensitive in both lichen planus (LP) and MMP. What does this study add?. The ODSS has been shown to be a thorough, sensitive and reproducible, yet quick scoring tool for the assessment of oral involvement in MMP. Its versatility for use in oral PV, MMP and LP is an added advantage over other scoring methodologies. What are the clinical implications of this work?. We propose that the ODSS be used as a clinical scoring tool for monitoring activity in oral MMP in clinical practice as well as for use in multicentre studies.

Objectives The objectives of this research were to compare trends in applications and admissions to dentistry and medicine by sociodemographic status, country/region, academic experience and attainment, for UK domiciled students, and also to compare the odds of gaining admission to each course.Methods Secondary analysis of student data from University and College Admissions Services (UCAS) for focused, successful, UK domiciled applicants whose preferred subject was medicine or dentistry from 1996-2011. Trends for both programmes were examined using univariate and multivariate analysis including logistic regression, both with and without tariff scores.Results Admission ratios to dentistry and medicine are similar, fluctuating over this period. These professions attracted more applications from females, people of Asian ethnicity, direct entrants to university, pupils from selective schools and Londoners. Males, students of White and Black ethnicity, those from England (excluding London), and from lower social groups, were under-represented. The odds of applicants gaining admission were lowest if male, mature (>20 years), of Black ethnicity, from a lower socioeconomic classification, or domiciled in England. When tariff was included in the model, the odds of acceptance for dentistry and medicine were higher for applicants achieving high tariff scores.Discussion This analysis highlights geographic disparities and demonstrates how certain groups remained under-represented, with social inequalities clearly reflected in admissions. The complexity of the societal challenge in accessing these courses must not be underestimated. Social status, geographic region and selective schools remain important determinants of entry, emphasising the importance of educational reform.

Background Accepted 'standard practice' for the diagnosis of immunobullous disease is a perilesional sample for direct immunofluorescence (DIF). Objectives To compare diagnostic outcomes of a normal buccal punch biopsy (NBPB) with a perilesional biopsy (PLB) for mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Methods A retrospective analysis of 251 DIF-positive patients with MMP and 77 DIF-positive patients with PV was undertaken. Parameters analysed included the intraoral sites of involvement and histopathological, DIF and indirect immunofluorescence (IIF) findings. Results For MMP, PLB was positive in 134 of 143 (93·7%) samples, compared with 129 of 144 (89·6%) by NBPB. The diagnostic sensitivities for PLB (81%, 39 of 48) and NBPB (77%, 37 of 48) among 48 patients who underwent both techniques were not significantly different (P = 0·62). In gingival-only MMP, PLB was positive in 63 of 69 (91%) and NBPB was positive in 63 of 75 (84%). For multisite MMP, PLB was positive in 71 of 74 (96%) and NBPB was positive in 66 of 69 (96%). In gingival-only MMP, biopsies from reflected alveolar mucosa in 17 consecutive patients were positive in 17 of 17 cases (100%). For PV, PLB was positive in 42 of 43 (98%), compared with 42 of 42 (100%) by NBPB. Histopathology was diagnostic in 93 of 134 (69·4%) cases of MMP and 38 of 41 (93%) cases of PV. IIF was positive in 126 of 197 (64·0%) MMP and 68 of 74 (92%) PV patient sera. Conclusions In the largest series of combined oral DIF results in patients with MMP and PV, we have shown that NBPB is equivalent to PLB for the diagnosis of PV and multisite MMP, and is more sensitive than both histology and IIF. What's already known about this topic? The variation in sensitivity of oral biopsy sites for direct immunofluorescence (DIF) in the diagnosis of oral MMP and PV has not been studied in detail in large series of patients. Biopsy can be challenging due to difficult access and fragility of the oral mucosa. The diagnostic biopsy technique is therefore critical. What does this study add? We have shown that a normal buccal punch biopsy (NBPB) from uninvolved oral mucosa is as sensitive as a perilesional biopsy (PLB) for diagnosis of oral PV, and superior to serology and histology. For multisite MMP, NBPB is equivalent to PLB and is more sensitive than serology and histology. The oral punch biopsy technique on uninvolved buccal mucosa tissue is a simple and safe practical method for diagnosing oral PV and MMP.

Aims To identify students' perceptions of barriers to effective study and the relationship between these and demographic characteristics, levels of perceived stress and examination performance. Materials and Methods A questionnaire was distributed to first (BDS1) and final year (BDS5) King's College London dental undergraduates, during Spring 2013. Data were collected on students' social and working environment using a Likert scale from zero to four. Levels of perceived stress and end-of-year examination results were collected. Statistical analyses were undertaken using SPSS® and Stata® software. Results A response rate of 83.0% (BDS1) and 82.9% (BDS5) was achieved. Social distractions were perceived to hinder study, with median scores of two and three for females and males respectively. The mean perceived stress score differed significantly (p = 0.001) between males and females. Difficulties with journey was a significant predictor of perceived stress (p = 0.03) as were family responsibilities (p = 0.02). Social distractions were significantly related to examination performance (p = 0.001). Conclusions Social distractions were the barrier most highly rated as hindering effective study. Levels of perceived stress were high and were significantly associated with gender, a difficult journey to university and family responsibilities. Social distractions were significantly related to examination performance; students rating social distractions highly, performed less well.

Introduction .The use of dental panoramic radiographs to assess dental development is hindered by the distortion and artefacts associated with such radiographic exposure techniques. Objective The purpose of this communication is to explore the feasibility of using CBCT to measure the bone buccal to lower third molars to determine the possible cause of loss of root pulp visibility as visualised on conventional dental panoramic tomographs. Material and Methods The radiographic archives of The Royal London Hospital were searched for suitable CBCT images. These were examined using Vatech Ewoo CBCT scanner and Pax Reve 3D software. Scans were reformatted into the required parasagittal, axial and coronal sections using SECTRA PACS (Picture Archiving & Communication) software. Measurements of specified parameters were made and the average of these measurements was used to estimate the width of tooth and bone buccal to the pulp that contributed to the loss of Root Pulp Visibility. Results There was concordance between the measurements for the left and right side for the average measurement of the dentine and bone buccal to the pulp. Conclusions The dentine and bone buccal to the pulp of the lower third molar roots is symmetrical. Further work is needed to explore the value of this technique to Dental Age Estimation.

A prospective randomized study was undertaken to compare conventional study model-based manual Peer Assessment Rating (PAR) scoring with computer-based automated scoring using scanned study models or intraoral scanning.The sample consisted of 67 patients, mean age 15.03 (range 11-37) years. Sixty-seven patients underwent alginate impression-taking and intraoral scanning (CS 3600; Carestream Dental, Stuttgart, Germany) at a single appointment in a randomized order. For each patient, a weighted PAR score was calculated manually by a calibrated examiner using study models and a PAR ruler (conventional group), and automatically using Carestream Dental CS Model+ software and data from scanned study models (indirect digital group) or intraoral scans (direct digital group). All procedures were timed, and each patient completed a binary questionnaire relating to their experience.There were no significant differences between methods for calculated mean weighted PAR score (P = 0.68). Mean (standard deviation) chairside time for impression-taking was 5.35 (± 1.16) minutes and for intraoral scanning, 7.76 (± 2.76) minutes (P 0.05). Mean (standard deviation) times taken to calculate weighted PAR scores were 2.86 (± 0.96), 5.58 (± 2.33), and 4.58 (± 2.18) minutes for conventional, indirect digital, and direct digital groups, respectively (P 0.05). A total of 61 patients (91%) preferred intraoral scanning to impression-taking.Automated PAR scoring using cast study models or intraoral scanning is valid, though both methods take longer than conventional scoring. Patients prefer intraoral scanning to impression-taking.ClinicalTrials.gov (NCT03405961).The protocol was not published before study commencement.

BACKGROUND Pemphigus vulgaris (PV) is a rare autoimmune bullous disease, which can present with recalcitrant oral mucosal lesions. Optimal management of PV relies upon careful clinical assessment and documentation. OBJECTIVES The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in PV. A secondary aim was to compare its inter- and intraobserver variability and ease of use with the Physician's Global Assessment (PGA) and the oral scoring methods used in the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI). METHODS Fifteen patients with mild-to-moderately severe oral PV were scored for disease severity by 10 oral medicine clinicians using the ODSS, the PGA and the oral sections of ABSIS and PDAI. Two clinicians rescored all patients after a minimum 2-h interval. RESULTS Interobserver reliability was assessed using an intraclass correlation coefficient (ICC). For the ODSS total score the ICC was 0·83, for PDAI (oral total activity) 0·79, ABSIS (oral total) 0·71 and PGA 0·7. Intraobserver agreement between initial scoring and rescoring of the same patient by two clinicians demonstrated an ICC for each of 0·97 and 0·96 for ODSS total score; 0·99 and 0·82 for PDAI oral activity; 0·86 and 0·45 for ABSIS total; and 0·99 and 0·64 for PGA. Convergent validity was good, with a correlation coefficient > 0·5 (P < 0·001). The mean ± SD times taken to complete each scoring method were ODSS 76 ± 37 s, PDAI 117 ± 16 s and ABSIS 75 ± 19 s. CONCLUSIONS This study has validated the ODSS for the assessment of oral PV. It has shown superior inter- and intraobserver reliability to PDAI, ABSIS and PGA and is quick to perform.

A single-blind randomized controlled clinical trial in patients with deep caries and symptoms of reversible pulpitis compared outcomes from a self-limiting excavation protocol using chemomechanical Carisolv gel/operating microscope (self-limiting) versus selective removal to leathery dentin using rotary burs (control). This was followed by pulp protection with mineral trioxide aggregate (MTA) and restoration with glass ionomer cement and resin composite, all in a single visit. The pulp sensibility and periapical health of teeth were assessed after 12 mo, in addition to the differences in bacterial tissue concentration postexcavation. Apical radiolucencies were assessed using cone beam computed tomography/periapical radiographs (CBCT/PAs) taken at baseline 0 mo (M0) and 12 mo (M12). In total, 101 restorations in 86 patients were placed and paired subsurface, and deep (postexcavation) dentin samples were obtained. DNA was extracted and bacteria-specific 16S ribosomal RNA gene quantitative polymerase chain reaction was performed. No significant difference was found in bacterial copy numbers normalized to mass of dentin (“bacterial tissue concentration”) between the self-limiting (96.3% reduction) and control protocols (97.1%, P = 0.33). The probability of 12-mo success was 4 times (odds ratio [OR] = 4.33; confidence interval [CI], 1.2–15.6; P = 0.025) higher in the self-limiting protocol compared to the control (conventional excavation technique), with pulp survival rates of 73.3% and 90%, respectively ( P = 0.049). Molars had a 4 times higher probability of success compared to premolars (OR, 4.17; CI, 1.17–14.9; P = 0.028), and symptom severity did not statistically predict outcome (OR, 0.41; CI, 0.12–13.9, P = 0.153). CBCT detected significantly more periapical (PA) lesions than PA radiographs at the baseline visit ( P < 0.001). In conclusion, the self-limiting caries excavation protocol under magnification increased pulp survival rate compared to rotary bur excavation ( ClinicalTrials.gov NCT03071588).

Introduction A national follow‐up survey was undertaken to determine whether dental graduates from 2009 perceived that their undergraduate oral surgery education had equipped them for general dental practice 4 years after graduating. Materials and Methods Graduates from the same 13 United Kingdom dental schools who had taken part in the original survey were invited to take part in this follow‐up online survey. Their contact details were identified via the general dental council register, social media and alumni groups. Results In total, 161 responded (2009b) which represents 16% of the graduates of the original survey in 2009a. A similar percentage of these respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practice (83% and 79% in 2009a and 2009b, respectively). Most respondents (99% in both years) reported confidence in undertaking simple forceps exodontia. Confidence in surgical exodontia was poor in both surveys, but one area that appeared improved in the follow‐up related to the sectioning of teeth (84% in 2009b compared with 49% in 2009a). Areas of weakness identified in 2009 were reported to be improved in the follow‐up. Conclusion This follow‐up survey supports the findings of the original survey. Future longitudinal studies would allow institutions to identify possible weaknesses in their curriculum and to track the career development of their graduates and facilitate robust data collection.

To evaluate the effect of pre-conditioning enamel white spot lesion (WSL) surfaces using bioactive glass (BAG) air-abrasion prior to remineralization therapy.Ninety human enamel samples with artificial WSLs were assigned to three WSL surface pre-conditioning groups (n=30): (a) air-abrasion with BAG-polyacrylic acid (PAA-BAG) powder, (b) acid-etching using 37% phosphoric acid gel (positive control) and (c) unconditioned (negative control). Each group was further divided into three subgroups according to the following remineralization therapy (n=10): (I) BAG paste (36 wt.% BAG), (II) BAG slurry (100 wt.% BAG) and (III) de-ionized water (negative control). The average surface roughness and the lesion step height compared to intra-specimen sound enamel reference points were analyzed using non-contact profilometry. Optical changes within the lesion subsurface compared to baseline scans were assessed using optical coherence tomography (OCT). Knoop microhardness evaluated the WSLs' mechanical properties. Raman micro-spectroscopy measured the v-(CO3)(2-)/v1-(PO4)(3-) ratio. Structural changes in the lesion were observed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDX). All comparisons were considered statistically significant if p0.05.PAA-BAG air-abrasion removed 5.1 ± 0.6 μm from the lesion surface, increasing the WSL surface roughness. Pre-conditioning WSL surfaces with PAA-BAG air-abrasion reduced subsurface light scattering, increased the Knoop microhardness and the mineral content of the remineralized lesions (p0.05). SEM-EDX revealed mineral depositions covering the lesion surface. BAG slurry resulted in a superior remineralization outcome, when compared to BAG paste.Pre-conditioning WSL surfaces with PAA-BAG air-abrasion modified the lesion surface physically and enhanced remineralization using BAG 45S5 therapy.

Introduction The influence of floor (lowest) and ceiling (highest) effects on the outcome measure is of serious concern particularly when the outcome is measured using Likert scales. Conventional regression methods yield biased results and hence tobit regression is to be used to adjust for these effects. This paper is an attempt to use tobit regression in finding the predictors of oral health related quality of life after adjusting for floor and ceiling effects. Methods A sample of 360 participants were asked to self asses their oral health related quality of life (OHRQoL) using Oral Health impact profile with 14 items which forms the data for this study. Apart from descriptive statistics, Ordinary Least squares regression and tobit regression were used to find the significant predictors of OHRQoL and the results of both methods were compared. Results The sample comprised of 41.1% men and 58.9% women. Majority of the participants (68.3%) were whites. The average item difficulty was 0.4 and the average item easiness was 0.03. The floor and ceiling values for the composite scores were 14 and 56 respectively. Age and gender were not statistically significant both in Ordinary Least Squares (OLS) regression and Tobit regression. Full time employment, student and retired have significantly lower scores in OLS but only retired had significantly lower scores in the tobit model. Conclusion Tobit model, after adjusting for floor and ceiling effect, gives higher values for the predictors and the OLS model underestimates the effects of predictors on OHIP scores.

The aim of this in-vivo study was to compare total protein and four key salivary proteins present in the acquired enamel pellicle (AEP) on eroded and non-eroded surfaces in participants with erosive tooth wear. Participants with erosive tooth wear of dietary non-intrinsic origin, present on the occlusal surfaces of the lower first molars and an unaffected posterior occlusal surface in the same quadrant were recruited from restorative dental clinics at King’s College London Dental Institute (n = 29, REC ref 14/EM/1171). Following removal of the salivary film, AEP samples were collected from the eroded occlusal surfaces (EP, n = 29) and the non-eroded occlusal surfaces (NP, n = 29) using 0.5% sodium dodecyl sulfate (SDS) soaked filter papers. Total protein concentration was analysed using bicinchoninic acid assay (BCA). Protein fractions were separated using SDS-PAGE and immunoblotted against: mucin5b, albumin, carbonic anhydrase VI (CA VI) and statherin antibodies. Amounts were quantified using ImageLab software against purified protein standards of known concentration. ANOVA followed by paired t-test and Wilcoxon’s matched-pair signed-rank test were used to test statistical significance. The difference was considered to be significant at a P value < 0.05. The total protein on eroded surfaces was significantly lower compared to the total protein on non-eroded surfaces [0.41mg/mL (0.04) and 0.61 mg/mL (0.11)] respectively (p< 0.05). The median (min, max) amount of statherin was also significantly lower on eroded occlusal surfaces [84.1 (20.0, 221.8) ng] compared to AEP from non-eroded teeth in the same subjects [97.1(30.0, 755.6) ng] (p = 0.002). No statistical differences were observed for mucin 5b, albumin or CA VI. The total protein and statherin in the in-vivo AEP were different between eroded and non-eroded tooth surfaces of the same patient.

Background Adults with dental phobia have been reported to have poorer oral health and oral health-related quality of life. The aim of this study is to explore the social and demographic correlates of oral health and oral health-related quality of life (OH-QoL) of people with dental phobia compared to the non-phobic population in the United Kingdom using the data from Adult Dental Health Survey (ADHS, 2009).Method Secondary analysis of data from the ADHS, 2009. A series of logistic regression analyses was performed with outcome measures of: presence of decayed teeth; presence of missing teeth; pulp exposure ulceration fistula abscess (PUFA) score; periodontal health indices (plaque, bleeding and loss of attachments); and quality of life (oral health impact profile [OHIP14] and oral impacts on daily performance [OIDP]). Predictors included in the models were: the presence of dental phobia; age; gender; occupational status; oral health-related behaviour; dietary intake of sugars; and perception of their last visit.Results People with dental phobia are more likely to have one or more decayed (caries) teeth/missing teeth. Furthermore, their self-reported oral health-related quality of life (OH-QoL) is poorer. There were no differences in PUFA scores or periodontal disease.Conclusion The impact of dental phobia on oral health appears to operate largely through the increased likelihood of the presence of caries, since there is an increased likelihood of the presence of teeth with active caries and missing teeth when other predictors of disease experience are controlled in the analysis.

Swept-source optical coherence tomography (SS-OCT) shows potential for the in vivo quantitative evaluation of micro-structural enamel surface phenomena occurring during early erosive demineralization. This randomized controlled single-blind cross-over clinical study aimed to evaluate the use of SS-OCT for detecting optical changes in the enamel of 30 healthy volunteers subjected to orange juice rinsing (erosive challenge) in comparison to mineral water rinsing (control), according to wiped and non-wiped enamel surface states. Participants were randomly allocated to 60 min of orange juice rinsing (pH 3.8) followed by 60 min of water rinsing (pH 6.7) and vice versa, with a 2-week wash-out period. In addition, the labial surfaces of the right or left maxillary incisors were wiped prior to SS-OCT imaging. An automated ImageJ algorithm was designed to analyse the back-scattered OCT signal intensity (D) after orange juice rinsing compared to after water rinsing. D was quantified as the OCT signal scattering from the 33 µm sub-surface enamel, normalised by the total OCT signal intensity entering the enamel. The back-scattered OCT signal intensity increased by 3.1% (95% CI 1.1-5.1%) in the wiped incisors and by 3.5% (95% CI 1.5-5.5%) in the unwiped incisors (p < 0.0001). Wiping reduced the back-scattered OCT signal intensity by 1.7% (95% CI -3.2 to -0.3%; p = 0.02) in comparison to the unwiped enamel surfaces for both rinsing solutions (p = 0.2). SS-OCT detected OCT signal changes in the superficial sub-surface enamel of maxillary central incisor teeth of healthy volunteers after orange juice rinsing.

a b s t r a c t The aims of this study were to assess: (a) the chemistry, morphology and bioactivity of bio-active glass (BAG) air-abrasive powder, (b) the effect of three air-abrasion operating parameters: air pressure, pow- der flow rate (PFR) and the abrasive powder itself, on the selective removal of resin composite and (c) the required "time taken". BAG abrasive particles were characterised using scanning electron microscopy- energy dispersive X-ray spectrometry (SEM-EDX) and Fourier-transform infrared spectroscopy (FTIR). Standardised resin composite restorations created within an enamel analogue block (Macor TM ) in vitro, were removed using air-abrasion undersimulated clinical conditions. 90 standardised cavities were scanned before and after resin composite removal using laser profilometry and the volume of the result- ing 3D images calculated. Multilevel linear model was used to identify the significant factors affecting MacorTM removal. BAG powder removed resin composite more selectively than conventional air-abrasion alumina powder using the same operating parameters (p < 0.001) and the effect of altering the unit's oper- ating parameters was significant (p < 0.001). In conclusion, BAG powder is more efficient than alumina in the selective removal of resin composite particularly under specific operating parameters, and therefore may be recommended clinically as a method of preserving sound enamel structure when repairing and removing defective resin composite restorations.

Introduction: A randomized controlled trial was undertaken to compare the efficacy of 3 methods of delivering information on short- and long-term recall of information in orthodontic patients and parents. Methods: Participants who received an audiovisual presentation on orthodontic treatment were randomly allocated to 1 of 3 written information groups (leaflets, generic mind map, or participant's customized mind map). A questionnaire was used to assess short- and long-term retention of information (maximum score 30). Results: Eighty-eight patients (94.6%) and 77 parents (86.5%) completed the study. The average knowledge scores at baseline for the patient groups were 17.71 95 CI 16.28-19.14), 16.58 (14.67-18.49), and 17.37 (15.92-18.81), respectively. The parents' knowledge scores for the 3 groups were 19.06 (17.51-20.62), 19.39 (17.44-21.35), and 18.76 (17.19-20.33), respectively. The short- and long-term knowledge scores improved over baseline in all 3 groups (P Conclusions: Provision of an audiovisual presentation supplemented with 1 of 3 written information methods is an effective way of delivering information. There was a significant improvement in the retention of information with the use of mind maps compared with leaflets. The generic mind map is equally as effective, more consistent in information delivered, and less labor intensive than the individual customized mind map and therefore would be our recommendation. Participation of parents is important because they comprehend and retain information better. In this study, 100% of parents shared information with their children, perhaps improving the patients' recall.

Patients with chronic musculoskeletal pain are frequent users of healthcare. Whilst evidence suggests that a multidisciplinary pain management programme (PMP) approach is effective in reducing patients’ levels of distress and disability, there is little research examining the cost-effectiveness of such an approach. The present study sought to address this by examining the impact a PMP had on patients’ pain-related secondary care healthcare use. A 90.5% reduction in healthcare use was found 12 months after the PMP, compared with 12 months before the PMP. The cost of the pain-related healthcare use 12 months before the PMP was £35,700. Twelve months after the PMP, the cost of healthcare use had reduced to £3879. The findings suggest that a PMP approach could reduce pain-related healthcare use.

The final stage of third molar development is used to assign a subject to above the 18-year threshold. Some subjects exhibiting this final stage are less than 18 years. Radiographs from 1000 females and 1000 males age 16.00–25.99 years were examined. Each half-year age band comprised 50 females and 50 males. Three categories of root canal widths (RCW) of the LL6, LL7, and LL8 [FDI 36, 37, and 38] were defined. Reproducibility was achieved by re-assessing the same subjects 12 months apart. For females, the minimum value for RCW-A was 16.33 years, RCW-B 17.23 years, and RCW-C 18.45 years. For males, the minimum values were RCW-A 17.16 years, RCW-B 18.29 years, and RCW-C 18.16 years. The presence of RCW-C in a female, and the presence of RCW-B or RCW-C in a male is compelling evidence that the subject is above the 18-year threshold.

The purpose of this paper was to explore the potential application of Root Pulp Visibility (RPV) to determine whether or not a subject of unknown date of birth is under or over the 18 year threshold. Patients, materials and methods Two thousand Dental Panoramic Radiographs comprising equal numbers of females and males evenly distributed between the ages of 16 and 26 years were examined. All third molars were scored using the Anglo-Canadian 8 Stage Tooth Development system [1] . The Lower Left Third Molar was censored to avoid redundant data being included in the data array for the Age at Attainment of Stage H, the final stage of tooth development (Roberts et al., 2015 [2] ). A filter cascade was applied to the data to select the data array for 1. Teeth in the final stage of development, 2. Female or male gender, 3. The definitive stage of RPV: RPV-A, RPV-B, RPV-C, or RPV-D. Results The summary data for each of these stages was derived and the minimum value for each was used to determine the relationship of the minimum value of A, B, C or D to the 18 Year threshold. It was found that for both females and males the minimum value for RPV-A and RPV-B indicated that subjects displaying this could be under 18 years old. For RPV-C and RPV-D, the minimum values show unequivocally that for both females and males the subject was over 18 years old. Conclusion RPV has an important role in unambiguously determining whether a subject is below or above the 18 year threshold.

BackgroundClinical experience suggests that there is a difference in survival between anterior and posterior all ceramic restorations.ObjectivesThis systematic review compared the difference in survival for full coverage all-ceramic materials used in adults to restore anterior or posterior vital teeth, not involved with fixed dental prostheses, but opposed by teeth.Data and sourcesSearches using Medline, Embase, and the Cochrane Library, including hand searches, with the inclusion criteria containing all-ceramic full coverage crowns in human adults over 17 years of age, prospective and retrospective studies, opposed by teeth, periodontal pocketing ≤5 mm, but not involving implant supported crowns or non-vital teeth. All papers were published between 1980 and March 2014 and available in English. From the selected studies a meta analysis was undertaken. The chi square test, I2, Begg’s and Egger’s test were analysed and the publication bias was assessed using a Funnel plot. The, Kappa scores were 0.63, 0.88, and 0.81 at each selection stage.Study selectionsPooled data produced 1112 anterior crowns with 73 failures (6.5%) and 1821 posterior crowns with 166 failures (9.1%) with a follow up time from 36 to 223 months. Relative risk meta-analysis of the 14 selected papers demonstrated that anterior all-ceramic crowns were 50% less likely to fail than posterior all-ceramic crowns (p = 0.001).ConclusionThese results indicate that there were differences in failure between anterior and posterior all ceramic crowns but the difference was only 3%. Although this has clinical relevance and some caution is needed when prescribing all ceramic posterior crowns the difference was relatively small.Clinical significanceThe clinically relevant results of this review, based on currently available data, demonstrate a need for some caution when considering posterior all-ceramic crowns. Lithium disilicate restorations were observed to have higher failures on anterior restorations and more research is needed to investigate why.

PurposeA psychometrically validated measure is needed to evaluate outcomes in carers of people with mental health problems, including dementia. This study aims to develop and validate the Carer well‐being and support questionnaire (CWS).Design/methodology/approachDevelopment and evaluation of the measure was conducted in three phases. The authors deconstructed an existing questionnaire (CUES‐C) to produce a long version measure. This was trialed with carers to reduce the number of items and a preliminary evaluation of the psychometric properties of the remaining items was undertaken. A second field test was conducted with the item‐reduced questionnaire measure to evaluate acceptability, reliability and validity.FindingsThe CWS well‐being scale shows moderate acceptability and good reliability and validity. The CWS support scale shows moderate acceptability and good reliability; validity testing for the support scale is limited by the lack of appropriate validating measures.Practical implicationsThe CWS is a reliable, valid measure of carer well‐being and support, reflecting important aspects of carers' lives.Originality/valueThis paper provides researchers and practitioners with a tool that can be used to measure and address areas of support for carers. This is important in assessing the effectiveness of new interventions and approaches.

Objective This study explored, and compared, the attitudes of student groups trained at the University of Portsmouth Dental Academy (UPDA) in 2010/2011 towards dental interprofessional education (IPE). Methods The study population consisted of fifth-year student dentists (n = 80) from King's College London Dental Institute, second- and third-year dental hygiene and therapy (n = 38) and first-year dental nursing (n = 14) students from UPDA. A 19-item, validated and dentally modified questionnaire, ‘Readiness for Inter-Professional Learning Scale (RIPLS)’, was administered. RIPLS contains three subscales: teamwork and collaboration, professional identity and roles and responsibilities. Mean (x¯) and standard deviation (SD) of the scores were calculated, following reversal of negative items. All the analyses were carried out using SPSS version 20 and STATA version 11. Results An overall response rate of 71% (n = 94) was achieved. In reference to teamwork and collaboration, all groups strongly indicated that IPE can contribute to learning teamwork skills (x¯ = 24.98, SD = 3.5) and improving relationships with team members (x¯ = 12.93, SD = 1.63); however, the scores did not differ between the groups (P = 0.09 and P = 0.16, respectively). Concerning professional identity, student dentists had significantly higher preference for a discipline-based approach (P = 0.002); were more likely to agree that ‘it is not necessary for undergraduate dental and dental care professional students to learn together’ (P = 0.01); and perceived that ‘clinical problem-solving skills can only be learnt effectively with other students from their own discipline’ (P = 0.02) than dental hygiene and therapy students. In relation to roles and responsibilities, participants demonstrated a strong sense of their own professional role. Student dentists reported that they had ‘to gain more knowledge and skills’ than dental hygiene and therapy (P = 0.01) and dental nursing (P = 0.01) students. Dental hygiene and therapy students were less likely than student dentists to agree that ‘the role of dental nurses and hygienists was to mainly provide support for dentists’ (P = 0.001). Conclusion The findings suggest that IPE was perceived as beneficial in relation to teamwork; however, the study raises issues regarding professional identity and roles. Educators should consider differing perceptions of professional roles and identities when planning and delivering interprofessional programmes.

Introduction The final stage of dental development of third molars is usually helpful to indicate whether or not a subject is aged over 18 years. A complexity is that the final stage of development is unlimited in its upper border. Investigators usually select an inappropriate upper age limit or censor point for this tooth development stage. Materials and methods The literature was searched for appropriate data sets for dental age estimation and those that provided the count (n), the mean ( x ¯ ), and the standard deviation (sd) for each of the tooth development stages. The Demirjian G and Demirjian H were used for this study. Upper and lower limits of the Stage G and Stage H data were calculated limiting the data to plus or minus three standard deviations from the mean. The upper border of Stage H was limited by appropriate censoring at the maximum value for Stage G. Results The maximum age at attainment from published data, for Stage H, ranged from 22.60 years to 34.50 years. These data were explored to demonstrate how censoring provides an estimate for the correct maximum age for the final stage of Stage H as 21.64 years for UK Caucasians. Conclusion This study shows that confining the data array of individual tooth developments stages to ± 3sd provides a reliable and logical way of censoring the data for tooth development stages with a Normal distribution of data. For Stage H this is inappropriate as it is unbounded in its upper limit. The use of a censored data array for Stage H using Percentile values is appropriate. This increases the reliability of using third molar Stage H alone to determine whether or not an individual is over 18 years old. For Stage H, individual ancestral groups should be censored using the same technique.

Insomnia is a very common and disabling symptom. Whilst evidence for the efficacy of cognitive behavioural therapy for people diagnosed with insomnia (CBT-I) is strong, few people seek help and not many services offer CBT-I. Less intensive adaptations of CBT-I have been shown to be valuable, and given the size of the problem and low rates of help-seeking, an accessible intervention with a large capacity is needed. Day-long CBT-I psycho-educational workshops (each for up to 30 people), to which members of the public with insomnia symptoms could self-refer, have been developed. This randomised controlled trial aimed to evaluate the effectiveness of these workshops. Baseline measures were taken from 151 participants, who were then randomised to experimental or waiting-list control groups. Scores of the experimental group and the control group were compared 3 months after baseline. Random effects models found a significant interaction between time and group, indicating differences between the control and experimental groups on the Insomnia Severity Index (ISI). Post hoc analyses indicated that ISI scores decreased significantly in the experimental group, but not in the control group. Promising results were also found on corroborative sleep diary measures. Access to the workshops was good, with 50% of participants having never previously sought help for sleep difficulties from their GP. CBT-I workshops proved to be both accessible and effective in reducing insomnia symptoms in the medium term. They may represent a feasible brief intervention with the potential to address unmet treatment needs of adults complaining of insomnia symptoms.