Search

Background\ud \ud Edentulous people eat less healthily, and wearing dentures impairs eating function and enjoyment.\ud Objective\ud \ud To apply a sequential approach to integrate scientific evidence, and patient and professional experience to co-develop intervention to support better eating with dentures.\ud Methods\ud \ud Focus groups, two with purposive samples of patients and two with dental professionals, explored experiences and opinions about advice on eating with complete dentures. Findings were distilled with evidence from the literature to underpinned concepts for eating interventions. User engagement informed prioritisation of ideas and led to the development of a leaflet on eating with dentures.\ud Results\ud \ud Patients receive no advice on what they can realistically expect when eating with dentures, and professionals lacked confidence to provide eating advice. Patients did not think dentists a credible provider of eating advice, feeling peer support more appropriate and offering numerous strategies for eating with dentures. Concepts for eating intervention included a patient leaflet, Web-based eating interventions, patient support blogs, waiting room videos and improved nutrition training for dental professionals. User feedback informed prioritisation of ideas, leading to the development of a leaflet on eating with dentures. Justified by the data, the leaflet focused on patient-generated tips for overcoming the functional limitations of eating with dentures, and unobtrusive healthier eating advice. Face validity with users confirmed acceptability.\ud Conclusion\ud \ud A systematic and rigorous integration of scientific evidence, expert experience and patient input has developed a patient-centric, evidence-based approach to a patent leaflet on eating with dentures that, based on initial face validity, is likely to be well received.

Objectives:\ud Antibiotic resistance is increasingly a growing global threat. This study aimed to investigate the potential use of newly developed scandium-doped phosphate-based glasses (Sc-PBGs) as an antibacterial and anticariogenic agent through controlled release of Sc3+ ions.\ud \ud Methods:\ud Sc-PBGs with various calcium and sodium oxide contents were produced and characterised using thermal and spectroscopic analysis. Degradation behaviour, ion release, antibacterial action against Streptococcus mutans, anti-matrix metalloproteinase-2 (MMP-2) activity, remineralisation potential and in vivo biocompatibility were also investigated.\ud \ud \ud Results:\ud The developed glass system showed linear Sc3+ ions release over time. The released Sc3+ shows statistically significant inhibition of S. mutans biofilm (1.2 log10 CFU reduction at 6 h) and matrix metalloproteinase-2 (MMP-2) activity, compared with Sc-free glass and positive control. When Sc-PBGs were mounted alongside enamel sections, subjected to acidic challenges, alternating hyper- and hypomineralisation layers consistent with periods of re- and demineralisation were observed demonstrating their potential remineralising action. Furthermore, Sc-PBGs produced a non-toxic response when implanted subcutaneously for 2 weeks in Sprague Dawley rats.\ud \ud Significance:\ud Since Sc3+ ions might act on various enzymes essential to the biological mechanisms underlying caries, Sc-PBGs could be a promising therapeutic agent against cariogenic bacteria.

Background Anterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, particularly in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation. Case presentation A 68-year-old woman with a history of RK with associated irregular astigmatism in both eyes and iris-fixated intraocular lens (IF-IOL) in the left eye presented with six months of decreased vision in the left eye. She was found to have Fuchs dystrophy and underwent DMEK surgery. She had an uncomplicated postoperative course, with uncorrected visual acuity improving to 20/20 three months after surgery. Conclusion To our knowledge, this is the first reported case of a highly successful DMEK surgery in a patient with prior RK and IF-IOL.

Since 2015 and the Montgomery ruling, the courts have informed healthcare workers in the UK of their duty "to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments". This legal standard for what constitutes sufficient information disclosure to allow consent to be classed as informed completed a swing from the previous paternalistic stance of the court to one based on a respect for the autonomy of each individual patient. Understanding the ramifications of this ruling and implementing the necessary changes to practice since then have represented a challenge to not just dentists but all healthcare workers.\ud \ud From March 2020, the impact of the COVID-19 pandemic has had a dramatic impact on dentists in the UK who have faced unprecedented challenges to the provision of every aspect of dental care. Following the first national lockdown that ended in early June 2020, general dental practitioners (GDPs) could reopen their doors and carry out face-to-face dentistry for the first time in more than 10 weeks. The restrictions to care were significant and highly impactful on the provision of urgent dental care in particular. \ud The aim of this project was to give an informed contribution to our understanding of how GDPs perceive the impact of both the Montgomery ruling and the restrictions imposed upon them following their return to work in June 2020. To achieve this aim, I proposed the following objectives: to explore how much time GDPs routinely allocate for a typical urgent pain appointment; to evaluate how GDPs feel that COVID-19 restrictions have impacted their ability to gain appropriately informed consent for patients in severe, acute pain; and to investigate how GDPs feel that the Montgomery ruling has affected their consent process, with particular reference to how they would go about obtaining consent for a clinical scenario presented in the survey.\ud \ud The views of GDPs across the UK were gained via a questionnaire-based survey that was distributed via a dental forum on the social media service provider Facebook. Drawing on data from 93 GDPs working in primary care in the UK, who responded to the survey, I was able to reveal the disproportionate impact of COVID-19 restrictions on those GDPs most reliant on NHS funding and the greater likelihood that these GDPs would offer shorter appointments and the lower likelihood that they would offer aerosol generating procedure (AGP) appointments for patients suffering with acute dental pain. The data also revealed that, overall, GDPs had a reasonable awareness and understanding of the Montgomery ruling and how it impacts on their consent processes for patients in pain although their perceived knowledge and actual knowledge were found to not always be consistent. \ud \ud Drawing conclusions from these findings, the thesis seeks to explore the ramifications of this unequal impact on the provision of urgent dental care. When looking at the reduced ability of those practices most reliant on NHS funding to provide the conditions for optimal care, the thesis draws into question the courts' ubiquitous approach to consent, applying it equally, as it does, across all clinical settings. It also asks questions relating to how regulatory and authoritative bodies within dentistry offer guidance and advice regarding urgent care when the delivery of it differs from practice to practice. The thesis then seeks to offer solutions in the form of suggesting future research that can help us better understand the training needs of the profession and looks at how regulatory advice and legal rulings can better reflect the disparity in the ability of the profession to deliver optimal urgent care.

Aim\ud\udTo investigate the effect of dentine conditioning agents on growth factor liberation and settlement of Dental Pulp Progenitor Cells (DPSCs) on dentine surfaces.\ud\udMethodology\ud\udThe agents used included ethylenediaminetetraacetic acid (EDTA; 10%, pH 7.2), phosphoric acid (37%, pH

Enhanced community surveillance is a key pillar of the public health response to coronavirus disease 2019 (COVID-19). Asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include preappointment and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centers across Scotland invited asymptomatic-screened patients aged over 5 y to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardized Viral Transport Medium–containing test kits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/email with appropriate self-isolation guidance in the event of a positive test. All positive cases were successfully followed up by the national contact tracing program. Over a 13-wk period (from August 3, 2020, to October 31, 2020), 4,032 patients, largely representative of the population, were tested. Of these, 22 (0.5%; 95% CI, 0.5%–0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. To our knowledge, this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing infection prevention control and PPE vigilance, which is relevant as health care team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.

Graphical abstract, Highlights • A hybrid stochastic/deterministic model of mouse rod phototransduction is presented. • Rod photocurrent to photovoltage conversion in darkness is accurately characterized. • Photoresponses to dim and bright stimuli and in various mutants are well reproduced. • Recently debated molecular mechanisms of the phototransduction cascade are examined., The phototransduction cascade is paradigmatic for signaling pathways initiated by G protein-coupled receptors and is characterized by a fine regulation of photoreceptor sensitivity and electrical response to a broad range of light stimuli. Here, we present a biochemically comprehensive model of phototransduction in mouse rods based on a hybrid stochastic and deterministic mathematical framework, and a quantitatively accurate description of the rod impedance in the dark. The latter, combined with novel patch clamp recordings from rod outer segments, enables the interconversion of dim flash responses between photovoltage and photocurrent and thus direct comparison with the simulations. The model reproduces the salient features of the experimental photoresponses at very dim and bright stimuli, for both normal photoreceptors and those with genetically modified cascade components. Our modelling approach recapitulates a number of recent findings in vertebrate phototransduction. First, our results are in line with the recently established requirement of dimeric activation of PDE6 by transducin and further show that such conditions can be fulfilled at the expense of a significant excess of G protein activated by rhodopsin. Secondly, simulations suggest a crucial role of the recoverin-mediated Ca2+-feedback on rhodopsin kinase in accelerating the shutoff, when light flashes are delivered in the presence of a light background. Finally, stochastic simulations suggest that transient complexes between dark rhodopsin and transducin formed prior to light stimulation increase the reproducibility of single photon responses. Current limitations of the model are likely associated with the yet unknown mechanisms governing the shutoff of the cascade.

Background: Increased demands for invasive and non-invasive treatments related to body image disturbances are seen worldwide. These demands may be related to body image dissatisfaction. No study to date investigated the relationship between body image dissatisfaction and dental anxiety (namely, anticipatory dental anxiety and treatment dental anxiety) among a non-clinical population. The current study aims to unveil such relationships. Methods: Dentally anxious people may choose to ‘cope’ with their anxiety via unnecessary invasive procedures related to their body image dissatisfaction. In the current study, 553 individuals completed an online survey assessing their dental anxiety, dental neglect, and body image via self-report questionnaires. Results: Body image dissatisfaction was significantly correlated with dental anxiety. In contrast to previous studies, dental neglect was negatively associated with dental anxiety. Additionally, no link was found between body image dissatisfaction and dental neglect. Conclusions: The current study highlights the importance of addressing these factors prior to invasive procedures. Publisher PDF

In the era of biomaterials evolution, ceramic materials are playing a notable role in dental practices. Ceramics have been used in dental applications for several decades because of its important properties such as suitable biological incorporation into human body, surface colouration, enhanced surface morphology, mechanical characteristics, physiochemical integration, durability and lifespan. There are numerous complications in the fabrication and production of ceramics by manufacturers. Therefore, many research and development has been performed to further improve and understand the manufacturing mechanism that occurs on the ceramic materials. These efforts are not only able to improve the fundamental understanding of the material but also help to meet the customer satisfaction and quality of production. This review article mainly provides an insight of various ceramic materials with a focus on their properties including stability, strength, and heat resistance. It is corroborated with a detailed account of various ceramic fabrication processing techniques with their applications that include sol-gel casting, hot pressing and phase inversion methods. In summary, some critical suggestions as well as detailed scope of future aspects and frontiers have been outlined to provide robust improvements for research and development platforms.

Objectives: To review patient characteristics, recommendations made and treatment outcomes of frail/older patients referred to a specialist multidisciplinary geriatric assessment and optimisation-based preoperative clinic (PROKARE), prior to patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). \ud Background: Although the use of preoperative comprehensive geriatric assessment to improve pre/peri and postoperative mortality has been reported for many surgical domains, its use prior to dental surgery has not been reported previously.\ud Methods: Data were collected retrospectively from the dental notes of 52 patients referred from the Special Care Dental (SCD) Department to the PROKARE service for optimisation prior to dental treatment under GA/CS using a case note study approach. Data extracted included patient demographic characteristics, medical history, clinical management and the treatment outcomes for each patient. The data extracted was analysed with descriptive statistics. \ud Results: Key reasons for referral were caries management, retained roots and poor co-operation. Multiple co-morbidities were noted among the patients referred, with 14 (27%) having four or more co-morbidities. The PROKARE assessment identified issues such as: treatment could be carried out under CS instead of GA; consent; and the need for medication change and/or further medical investigations. As per recommendations from PROKARE, 39 patients (75%) received dental treatment while five (10%) did not receive treatment, and a further eight (15%) died prior to treatment.\ud Conclusion: Geriatric assessment and optimisation-based preoperative clinics in the dental management of frail, elderly patients having treatment under GA or CS techniques is valuable, but further research and assessment of current service provision is needed to increase the evidence base.

Introduction\ud \ud The Erasmus+O-Health-EDU project aims to gain a comprehensive view of oral health professional (OHP) education in Europe, through the development of web-based surveys and online toolkits. A glossary to facilitate a common language through which academic teams could cooperate and communicate more accurately was identified as a key need within the project. The aim of ARTICULATE was thus to create a shared language, with a European focus, for terms and concepts used in the field of OHP education.\ud \ud \ud \ud Methods\ud \ud The methodology was developed from those published for construction of other glossaries with a circular and iterative process: the creation of content and definitions by a group of experts in OHP education, the testing of “fitness for purpose” of the content, and stakeholder consultation. All creation steps were followed by refinements based on testing results and stakeholder comments. The final glossary was then launched as an online resource including a built-in mechanism for user feedback.\ud \ud \ud \ud Results\ud \ud The scope and structure of the glossary were mapped out at a workshop with 12 dental education experts from 7 European countries. A total of 328 terms were identified, of which 171 were finally included in ARTICULATE. After piloting with a close group of other colleagues, the glossary was opened for external input. Thirty European Deans or Heads of Education assessed the definition of each term as “clear” or “not clear.” A total of 86 definitions were described as “clear” by all individuals. Terms deemed unclear by at least one individual were revisited and changes made to 37 of the definitions. In conjunction with the launch of the glossary, a range of stakeholder organisations were informed and asked to participate in an open global consultation by providing feedback online. Since its launch in June 2021, the ARTICULATE website (https://o-health-edu.org/articulate) has had an average of 500 visits/month. To promote community ownership, forms embedded on the ARTICULATE webpage allow users to give feedback and suggest new terms. A standing taskforce will meet regularly to consider amendments and make changes to ensure that the glossary remains a relevant and up-to-date resource over time.\ud \ud \ud \ud Conclusion\ud \ud ARTICULATE is a unique, evolving, online glossary of terms relating to OHP education, created as a resource for all interested OHP educators. The glossary is a key output of the O-Health-Edu project, which relies on a comprehensive vision of OHP education to address the future oral health needs of the European population.

Objective: Lockdown and other measures, including the closure of universities, introduced by Governments across countries in response to the COVID-19 pandemic have appreciably impacted on the education of dental and medical students across countries. Key challenges included the need to rapidly move to e-learning as well as instigate new approaches to practicals for health science students. This involves lecturers and students necessarily needing to rapidly adapt to e-learning and other approaches. There have also been affordability issues among students to regularly access the Internet, and purchase the necessary equipment, particularly among those from low- and middle-income countries such as Bangladesh. Consequently, there is an urgent need to assess current challenges among senior level physicians and educators in Bangladesh regarding the education of dental and medical students arising from the current pandemic, and how these are being addressed, to provide future direction. This is particularly important in Bangladesh with high rates of both infectious and non-infectious diseases. Materials and Methods: Pragmatic investigation involving a purposely developed questionnaire based on previous studies and the experience of the co-authors. The questionnaire was distributed to 15 senior-level educators with the findings analysed by themes. Results: Key issues included little experience with e-learning at the start of the pandemic among both staff and students, poor internet access and cost of internet bundles. In addition, fear and anxieties among both students and staff. The colleges responded by instigating teaching classes for educators on e-learning and providing adequate personal protective equipment for staff and students during teaching and practical sessions. These formed the basis of future recommendations. Other recommendations included increased flexibility among staff and students. Conclusion: The pandemic posed appreciable challenges to both staff and students attending dental and medical colleges in Bangladesh. Some of the key issues are starting to be addressed. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 444-454

Portland cement-based formulations blended with radiopacifying agents are popular endodontic materials for various root filling and pulp capping applications. Iodoform (CHI3) is an alternative candidate radiopacifier whose impact on the setting, bioactivity, antimicrobial properties and cytotoxicity of white Portland cement were evaluated in this study. Isothermal conduction calorimetry and 29Si magic angle spinning nuclear magnetic resonance spectroscopy (MAS NMR) showed that 20 wt% iodoform had no significant impact on the kinetics of cement hydration with respect to the formation of the major calcium silicate hydrate (C-S-H) gel product (throughout the 28-day observation). Conversely, transmission electron microscopy demonstrated that iodine was incorporated into the ettringite (Ca₆Al₂(SO₄)₃(OH)₁₂&middot, 26H₂O) product phase. Both iodoform-blended and pure Portland cements exhibited comparable biocompatibility with MG63 human osteosarcoma cells and similar bioactivity with respect to the formation of a hydroxyapatite layer upon immersion in simulated body fluid. By virtue of their high alkalinity, both cements inhibited the growth of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. However, in all cases, iodoform enhanced the antimicrobial effect and significantly reduced the minimum bactericidal concentration of the cement. In conclusion, iodoform offers antimicrobial advantages in Portland cement-based formulations where oral biofilm formation threatens the success of root filling materials and dentine substitutes. The reactivity with the calcium aluminosulfate components of the hydrating cement matrix warrants further research to understand the long-term stability of the cement matrix in the presence of iodoform.

Funded by the National Institute for Health Research Health Technology Assessment program (project number 07/44/03). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA program, NIHR, NHS or the Department of Health. The funders had no role in study design, data collection and analysis, or preparation of the manuscript. Background The Filling Children’s Teeth: Indicated Or Not? (FiCTION) randomised controlled trial (RCT) aimed to explore the clinical- and cost-effectiveness of managing dental caries in children’s primary teeth. The trial compared three management strategies: conventional caries management with best practice prevention (C + P), biological management with best practice prevention (B + P) and best practice prevention alone (PA)-based approaches. Recently, the concept of treatment acceptability has gained attention and attempts have been made to provide a conceptual definition, however this has mainly focused on adults. Recognising the importance of evaluating the acceptability of interventions in addition to their effectiveness, particularly for multi-component complex interventions, the trial design included a qualitative component. The aim of this component was to explore the acceptability of the three strategies from the perspectives of the child participants and their parents. Methods Qualitative exploration, based on the concept of acceptability. Participants were children already taking part in the FiCTION trial and their parents. Children were identified through purposive maximum variation sampling. The sample included children from the three management strategy arms who had been treated and followed up; median (IQR) follow-up was at 33.8 (23.8, 36.7) months. Semi-structured interviews with thirteen child-parent dyads. Interviews were transcribed verbatim and analysed using a framework approach. Results Data saturation was reached after thirteen interviews. Each child-parent dyad took part in one interview together. The participants were eight girls and five boys aged 5–11 years and their parents. The children’s distribution across the trial arms was: C + P n = 4; B + P n = 5; PA n = 4. Three key factors influenced the acceptability of caries management in primary teeth to children and parents: i) experiences of specific procedures within management strategies; ii) experiences of anticipatory dental anxiety and; iii) perceptions of effectiveness (particularly whether pain was reduced). These factors were underpinned by a fourth key factor: the notion of trust in the dental professionals – this was pervasive across all arms. Conclusions Overall children and parents found each of the three strategies for the management of dental caries in primary teeth acceptable, with trust in the dental professional playing an important role. Publisher PDF

Introduction: Dental anxiety is common and causes symptomatic use of oral health services. Objectives: The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. Methods: A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking. Results: Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001). Conclusion: Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080). Knowledge Transfer Statement: Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

This article represents an open repository of human enamel data collected/reconstructed from seven populations covering a 2000 year time period in Britain via five temporally distinct periods. In total data was collected from 285 permanent teeth, including maxillary and mandibular first molars, and maxillary canines and first incisors. Data was gathered through thin histological methods using standard procedures for sectioning human dental material. In regards to enamel growth, data is collected for daily secretion rates (DSRs) for the inner, mid, and outer areas of lateral and cuspal enamel. For enamel thickness average (AET) and relative (RET) enamel thickness, cuspal linear thickness (CT), and lateral linear thickness (LT) was collected. Alongside the data presented this article also provides clear and transparent explanations for all the methods involved in its production, in order to ensure understanding of the rigorous protocol and consistency associated with the data provided. The novel data is also contextualised with a compilation of equivalent data published in past articles.

Dental trauma resulting in permanent tooth avulsion commonly affects the young population. The prognosis of replantation after avulsion depends on the natural history of inflammatory and replacement resorption. Several risk factors for type and onset of external resorption have been defined. This case study describes different resorptive patterns observed in two upper central incisors belonging to a single individual, avulsed in the same moment, and replanted after thirty-six hours of dry storage. The roots were analyzed by scanning electron microscopy and stereomicroscope imaging, to obtain an in-depth analysis of the resorptive pattern. The aim of this report is to: (i) underline the high variability in the incidence of root resorption after replantation across and within types of teeth and resorption; and (ii) underline the possible concurrence of different factors affecting the onset and type of resorptive pattern. In conclusion, an unpredictable pattern of resorption may account for the poor prognosis when teeth are replanted outside the current recommendations.

There is a clinical need for a long acting topical anaesthetic formulation that could be applied by patients themselves, dentists, or health care professionals, therefore the project aim was to develop and prepare a mucoadhesive carrier for the buccal delivery of local anaesthetic (LA), embedded into fast disintegrating film to achieve sustained local pain relief. Novel transfersomes loaded with LA such as lidocaine could be a superior approach to improve patient compliance and achieve the required level of anaesthesia. Lidocaine-loaded transfersomes were optimised and formulated using a Taguchi design of experiment (DOE) in terms of phospholipid type, type of edge activator (EA) and ratio of phospholipid to EA. Transfersomes were characterised for size, polydispersity index (PDI), charge, and entrapment efficiency (%EE). The obtained transfersomes were 200 nm in size and with a good PDI around 0.3. A new HPLC method for lidocaine quantification was optimised and validated using a mobile phase of 30 % v/v PBS (0.01 M) and 70 % v/v Acetonitrile at a flow rate of 1 mL/min. Detection was carried out at 255 nm at 30 ˚C and the retention time was 2.84 minutes. Linearity was obtained over the range 0.1-2 mg/mL (R2 0.9999). The proposed method was shown to be valid for linearity, accuracy, sensitivity, intermediate precision and repeatability according to ICH guidelines. The %EE was dependent on the formulation parameters and was between 44-56%. Analysing the data by Taguchi DOE showed the effect of factors on both size and %EE were in the following rank order: lipid: EA ratio ˃EA type ˃lipid type. The type of lipid (natural or synthetic) showed no significant effect on transfersome size. Increasing the EA concentration reduced transfersome size, however, further increments of EA had an opposite effect, and transfersome size increased. Six transfersome samples were selected based on the analysis of the optimisation results, and their release profiles were assessed. All 6 samples proved that the optimised transfersomes can be used as a sustained release delivery system of LA as they released lidocaine slowly over 24h. It was believed that incorporation of mucoadhesive polymers into the delivery system would prolong their residence time at the buccal cavity. Thus, three different polymers (HPMC K4M, HPMC K15M, and chitosan HCl) were screened for forming a continuous coating layer, aiming to preserve the uniform nanosize of transfersomes as well as enhancing the %EE. There was a clear indication of coating layer formation as all formulations showed an increased size afterwards. However, transfersomes coated with HPMC K4M and K15M failed to keep the nanosize or homogenous distribution obtained with the uncoated ones. Although chitosan HCl coated transfersomes showed a slight increment in the size as well, except formulation F5 at low chitosan HCl concentrations (i.e. 0.1 and 0.2 % w/v). Not only did formulation F5 show a non-significant difference in size after coating with chitosan HCl but it also had a higher drug entrapment (84%) compared to the uncoated sample (49%). Therefore, the chitosan-coated formulation (F5-CH) was selected and tested for mucoadhesion and drug release properties. F5-CH exhibited a sustained release profile over 24 h with an immediate release of 23.4% during the first hour, which could guarantee the immediate effect of LA. These findings proposed a novel buccal drug delivery system utilising chitosan HCl coated transfersomes. Three different cell lines (NOK, MRC5, MRC5-SV2) were employed to confirm the safety of coated transfersomes. Which proved to be completely safe and non-toxic at the intended concentration to be delivered. The ex vivo model proved the successful formation of a sustained delivery system, as the drug released from the chitosan coated transfersomes slowly with 80% drug accumulation after 24 h. Single layer films loaded with the coated transfersomes were successfully developed using a mixture of mucoadhesive polymers (HPC and PVA). A simple casting method was used and the produced films disintegrated on average at 2.75 min. They showed good mechanical properties and flexibility, in addition to have a pH of 7.9 that is well tolerated in the buccal mucosa. The content uniformity was confirmed and the drug release from transfersomes was not affected by their loading into polymeric film.

ObjectiveTo investigate the fatigue trajectory during a 6-month duration of the COVID-19 pandemic for dental health professionals in primary dental care and for those in training.DesignA longitudinal intensive panel diary was conducted (July–December 2020) assessing weekly self-ratings of emotional fatigue.SettingDental care services in Scotland.ParticipantsDental trainees and primary dental care staff (N=53). These data were merged with respondents’ replies to a cross-sectional baseline survey (Humphris et al). Recruitment was through ‘Portal’, an online tool administered by National Health Service Education for Scotland. Questback software was employed for data collection.Primary and secondary outcome measuresThe diary questionnaire, consisted of a three-item fatigue scale and, from the baseline survey, three multi-item scales including: preparedness (14 items of the Dental Professional Preparedness for Practice Scale), the 22-item Impact of Event Scale-Revised and depressive symptomatology using the Patient Health Questionnaire-2. Statistical analysis included estimating the variability of fatigue over the study duration using a multilevel linear growth model. In addition, a path analysis was performed to determine the ability of preparedness and COVID-19 pandemic trauma to predict fatigue trajectories directly, or mediated through depressive symptomatology.ResultsA large variation of fatigue trajectories (pConclusionStaff who volunteered to participate over a significant period of the COVID-19 pandemic in Scotland displayed a highly significant variety of individual trajectories. The results show some consistency with a job demands-resources model of burnout development. Suitable resource structures are indicated for staff over periods of extensive public service change.

Education delivery in higher education institutions was severely affected by the COVID-19 pandemic, especially for healthcare students whose continuing education is imperative to maintain a well-educated healthcare workforce. Emergency remote teaching, without prior contingency planning, was\uddeveloped and adapted promptly for the circumstances. We investigated the effectiveness of alternative education delivery strategies during the COVID-19 pandemic to ensure medical, dental, nursing and pharmacy students acquired the relevant knowledge to become effective practitioners, able to translate learning into clinical practice, and how this informs either further planned education delivery or adaptations in emergencies.

Some researchers posit population continuity between Late Palaeolithic hunter–gatherers of the late Pleistocene and Holocene agriculturalists from Lower (northern) Nubia, in northeast Africa. Substantial craniodental differences in these time-successive groups are suggested to result from in situ evolution. Specifically, these populations are considered a model example for subsistence-related selection worldwide in the transition to agriculture. Others question continuity, with findings indicating that the largely homogeneous Holocene populations differ significantly from late Pleistocene Lower Nubians. If the latter are representative of the local populace, post-Pleistocene discontinuity is implied. So who was ancestral to the Holocene agriculturalists? Dental morphological analyses of 18 samples (1075 individuals), including one dated to the 12th millennium BCE from Al Khiday, near the Upper Nubian border, may provide an answer. It is the first Late Palaeolithic sample ( n = 55) recovered within the region in approximately 50 years. Using the Arizona State University Dental Anthropology System to record traits and multivariate statistics to estimate biological affinities, Al Khiday is comparable to several Holocene samples, yet also highly divergent from contemporaneous Lower Nubians. Thus, population continuity is indicated after all, but with late Pleistocene Upper—rather than Lower Nubians as originally suggested—assuming dental traits are adequate proxies for ancient DNA.

We would like to acknowledge funding for the Childsmile e-Health Project (Grant number: 803810) from the Scottish Government. The aim of this study was to explore communication interactions and identify phases adopted by dental professionals with parents and their young children and to examine the hypothesis that successful social talking between the actors together with the containment of worries allows the formation of a triadic treatment alliance, which leads to achieving preventive dental treatment goals. Conversation analysis of the transcribed data from video recordings of dental professionals, parents and preschool children when attending for preventive dental care was conducted. The transcriptions were read, examined and analysed independently to ensure the trustworthiness of the analysis. The transcriptions were explored for interactive patterns and sequences of interaction. Forty-four individual consultations between dental professionals, parents, and preschool children were recorded. The number of communication behaviours was 7,299, with appointment length ranging from 2 min 10 s to 29 min 18 s. Two patterns of communication were identified as dyadic (between two people) and triadic (between three people) interactions within a continuous shifting cycle. The three phases of communication were social talking, containing worries and task-focusing. Social talking was characterised by shifts between dyadic and triadic communication interactions and a symmetry of communication turns and containing worries. This typified the cyclical nature of the triadic and dyadic communication interactions, the adoption of talk-turn pairs, and triadic treatment alliance formation. Task-focusing pattern and structure were different for dentists and extended-duty dental nurses. For dentists, task-focusing was characterised by a dyadic interaction and as an asymmetrical communication pattern: for extended-duty dental nurses, task-focusing was typified by symmetrical and asymmetrical communication patterns within dyadic and triadic interactions. Empathy and understanding of the young child's emotional needs during containing worries allowed the formation of the triadic treatment alliance and with this treatment alliance, the acceptance of interventions to prevent early childhood caries during “task-focusing.” This qualitative exploration suggests that dyadic and triadic communication interactions are of a dynamic and cyclical quality and were exhibited during paediatric dental consultations. The communication phases of social talking, containing worries and task-focusing were evident. Successful social talking signalled the entry to containing worries and triadic treatment alliance formation which permitted the preventive goals of the consultation to be achieved (task-focusing). Future work should generate additional data to support the hypotheses created here namely that, social talking and containing worries triggers an integral pathway to task-focusing and the achievement of preventive dental goals. Publisher PDF

ObjectivesThe aim of this prospective case series study is to assess the three-dimensional (3D) skeletal and soft tissue effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in conjunction with a miniscrew-supported class III elastic wear in class III growing patients.Materials and methodsFourteen consecutive participants (mean age 12.05 ± 1.09 years), who displayed class III malocclusions with retrognathic maxillae, were recruited. A cone beam computed tomography (CBCT) scan was acquired before commencing treatment (T1). All participants were treated with a tooth-bone-borne rapid maxillary expansion (hybrid MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. This was followed by full-time class III elastics, delivering 400 g/side, to protract the maxilla. When a positive overjet was achieved, protraction was ceased and a post-treatment CBCT scan (T2) was taken. The 3D analysis of pre- and post-treatment CBCT scans was blinded. The scans were registered on the anterior cranial base. The Euclidean distance between the two extracted surface models of the pre- and post-treatment scans was displayed as a color surface map.ResultsAll participants completed the intervention successfully. The majority of the participants showed protraction of the anterior maxillary region (71.4%) and in the zygomatic processes (64.2%). The maxilla significantly protracted (SNA 1.87° ± 1.06°; Vert.T-A 3.29 ± 1.54 mm), while the mandibular base significantly redirected posteriorly (SNB − 2.03° ± 0.85°, Vert.T-B − 3.43 ± 4.47 mm) and that was reflected on the ANB and Wits measurements. No adverse effects were observed.ConclusionClass III elastics combined with the Alt-RAMEC activation protocol of the hybrid MARME appliance is an effective treatment method for mild/moderate class III malocclusions. A long-term follow-up and comparisons with other treatment modalities are required.

First Bite Syndrome (FBS) is a painful condition which classically presents as severe pain in the pre‐auricular region, initiated on the first bite of a meal. It is usually associated with a history of upper neck surgery or tumour of the parotid salivary gland or parapharyngeal space (PPS). Some propose FBS arises from damage to, or resection of, the cervical sympathetic trunk resulting in loss of sympathetic innervation to the parotid salivary gland. Idiopathic FBS has been reported only a handful of times in the literature. We present the case of a 51‐year‐old male, urgently referred to the Department of Oral Medicine, with a three‐week history of severe, sharp, unilateral pain from the right angle of mandible, intensity described as ‘20/10’, occurring only on the first bite of eating. This would diminish over two minutes. Clinical examination revealed tenderness over the right condylar neck and angle of mandible only. FBS was suspected and the patient immediately started on carbamazepine. An urgent MRI displayed no abnormalities of the TMJ, PPS, trigeminal nerve or parotid gland. Restorative Dentistry review confirmed no odontogenic/occlusal cause and on review, four months later the patient reported complete resolution of symptoms on 200mg of carbamazepine three times daily. This case highlights the importance of taking a thorough pain history. Patients with symptoms of FBS and no history of surgery to the neck should have an MRI to rule out parotid gland or PPS tumour. Carbamazepine can be successful in treating idiopathic FBS and can resolve symptoms completely.

Funding: This research was funded by the Tattersall foundation. The APC was funded by the University of Dundee Library and Learning Centre. Background and Objectives Disruption to taste and smell are common symptoms of COVID-19 infection. The current literature overlooks taste symptoms and tends to focus on the sense of smell. Persisting cases (>28 days) of taste dysfunction are increasingly recognised as a major future healthcare challenge. This study focuses on the severity and recovery of COVID-19 induced taste loss and association with olfactory symptoms, lifestyle and oral health factors. Materials and Methods This study was a cross-sectional survey comparing 182 rapid taste recovery participants (≤28 days) with 47 participants with prolonged taste recovery >28 days. Analyses of taste loss in association with smell loss, age, sex, illness severity, diet, BMI, vitamin-D supplementation, antidepressants, alcohol use, smoking, brushing frequency, flossing, missing teeth, appliances and number of dental restorations were conducted. Differences in the severity of the loss of sour, sweet, salt, bitter and umami tastes were explored. Results Both the severity and the duration of taste and smell loss were closely correlated (p < 0.001). Salt taste was significantly less affected than all other taste qualities (p < 0.001). Persisting taste loss was associated with older age (mean ± 95% CI = 31.73 ± 1.23 years vs. 36.66 ± 3.59 years, p < 0.001) and reduced likelihood of using floss (odds ratio ± 95% CI = 2.22 (1.15−4.25), p = 0.047). Conclusions Smell and taste loss in COVID-19 are closely related, although a minority of individuals can experience taste or smell dysfunction in the absence of the other. The taste of salt may be less severely affected than other taste qualities and future work exploring this finding objectively is indicated. The association of flossing with rapid taste recovery adds to the growing evidence of a link between good periodontal health and favourable COVID-19 outcomes. Publisher PDF

We would like to acknowledge the funding from the Scottish Government for the Childsmile Programme. Background : The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team. Aim : To apply PaeD‐TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child participation within an oral health promotion session. Method : A video observational study was applied. The sample consisted of a dental nurse and 22 children aged 2‐5 years in a general dental practice in Scotland. Behaviours were catalogued with time stamps using PaeD‐TrICS. Analysis of behavioural sequences with child participation as the dependent variable was conducted using multilevel modelling. Results : Children varied significantly in their participation rate. The statistical model explained 28% of the variance. The older the child and longer consultations significantly increased child participation. Both nurse and parental behaviour had immediate influence on child participation. Parental facilitation had a strong moderating effect on the influence of the nurse on child participation. Conclusions : Child participation was dependent on nurse and parent encouragement signalling an important triadic communication process. The coding scheme and analysis illustrates an important tool to investigate these advisory sessions designed for delivering tailored messages to young children and parents. Patient or Public Contribution : The dental staff, child patients and their parents were involved closely in the conduct and procedures of the present study. Publisher PDF

Background It is widely agreed that tobacco smoking has numerous consequences for the health of an individual. It is, therefore, imperative to encourage cessation. This project investigated whether or not smoking cessation advisors discussed with their clients the association between smoking and tooth loss.Aim To explore non-dental smoking cessation advisors’ knowledge base related to smoking tobacco and tooth loss and to learn whether or not they use it to educate their clients.Method A qualitative study methodology via semi-structured, face-to�face, audio-recorded interviews with 12 smoking cessation advisors was employed. The participants were purposively selected from local pharmacies that offered Stop Smoking Services (SSS) and via ‘One You East Sussex’ (OYES).ResultsSmoking cessation advisors had limited knowledge about the association between smoking and tooth loss and in turn provided limited information to their clients. However, all agreed that if clients had knowledge of this association, it might be a good motivator to encourage clients to stop smoking. ConclusionFurther studies are required to capture a broader range of knowledge and views from this under-examined group of practitioners. Information about tooth loss should be included in initial smoking cessation advisors training and current information should be available as part of their continuing education for more experienced smoking cessation advisors.

AimsTo identify the extent of cultural awareness teaching within the dental hygiene and dental therapy students’ academic curricula in the UK.Method A survey was administered via an online questionnaire (SmartSurvey©) and the link distributed by email to all 21 dental hygiene and dental therapy higher education institutes in the UK. Statistical Package for Social Science was used to process data.ResultsOf the 21 higher education institutes, 20 responded to the questionnaire. Regional division and variability in provision of cultural awareness education was found to be evident. Fourteen (n=20; 70%) delivered cultural awareness education through various modules, providers and allocated teaching hours. The six (30%) higher education institutes who did not provide cultural awareness education reported barriers to inclusion, either individual or joint: cultural awareness is not a General Dental Council requirement (n=2; 10%); lack of specially qualified staff (n=2; 10%); lack of timetable availability (n=3; 15%); cultural awareness was considered not a subject requiring inclusion (n=1; 5%).ConclusionTypically, in UK higher education institutes’ dental hygiene and dental therapy academic curricula, cultural awareness provision is integrated rather than afforded a distinct and specific profile. There is a gap in the curricula and thus an opportunity to strengthen the dental hygiene and dental therapy education to ensure that new graduates are specifically equipped in cultural awareness, so that they might reach members of the patient population from diverse ethnic backgrounds.