Is provision of contraception at discharge following delivery associated with postpartum visit attendance?

OBJECTIVES

We examined whether provision of contraception at discharge following delivery was associated with lower rates of postpartum visit (PPV) attendance.

METHODS

We conducted a retrospective cohort study of women who received pregnancy care at a Midwestern medical center in 2013. Attendance at the postpartum visit was compared for women with sterilization, contraception initiated prior to discharge (depot medroxyprogesterone acetate or etonogestrel implant), hormonal contraception prescription, or no contraception provided at postpartum discharge. Poisson regression models with robust standard errors were used to estimate the relative risk of postpartum visit attendance controlling for age, race, and parity, insurance status, and histories of both depression and drug abuse.

RESULTS

Of the 1015 women who met inclusion criteria, 55% had been prescribed contraception, had initiated contraception prior to discharge, or were sterilized at the time of discharge following delivery. After adjustment for confounders, there was no association between receiving contraception and PPV attendance (relative risk for prescribed contraception = 1.09 [95% CI 0.85, 1.39], for contraception initiated prior to discharge = 0.83 [95% CI 0.67, 1.03], for sterilization = 0.86 [95% CI 0.63, 1.17] compared to no contraception).

CONCLUSIONS

We found no evidence that prescribing or administering contraception post-delivery was associated with lower rates of return for postpartum follow up.

IMPLICATIONS

This single site study suggests that providing effective contraception at discharge following delivery does not appear to impact PPV attendance.

Reasons for placement and replacement of crowns in general dental practice

Objectives

The aim of this study was to investigate the reasons for placement and replacement of crowns in general dental practice.

Methods

Forty general dental practitioners recorded the principal reason for the provision of new (initial) and replacement crowns for a maximum of up to 20 patients over a 20-week period.

Results

A total of 664 patients received 783 crowns during the period of this study. Of these, 69% (n = 542) were new (initial) placements and 31% (n = 241) were replacements. Overall, tooth fracture (45%, n = 241) was the most frequently reported reason for new/ initial crown placements. Aesthetics (21%, n = 53) and secondary/recurrent caries (20%; n = 47) were the most frequent reasons for crown replacement. Maxillary premolars (27%, n = 145) and mandibular molars (25%, n = 137) were the teeth that received most initial crown placements. In contrast, maxillary incisors (50%, n = 115) were the most common teeth to receive a replacement crown. Dentists were more likely to replace a crown if they had not placed the original crown: 74% of replacement crowns (n = 178) were placed by a different dentist. Most patients had only one crown placed or replaced per course of treatment (n = 611; 90%).

Conclusions

The results of this study reveal the prescribing habits of dentists in relation to provision of initial and replacement crowns. The vast majority of patients had only one crown provided per course of treatment, which is probably a reflection of funding schemes and changing patterns of oral health. This sample reported fewer replacement crowns than previous studies. In keeping with existing literature, crowns were more frequently replaced when the treating dentist had not placed the initial crown. However, against this, more replacements were provided for more long-standing patients (5+ years attendance) compared to those with shorter attendance history (<5 years). In an area where high quality evidence is lacking, further consensus on the need for placement and replacement crowns is needed. Such information would assist dentists to provide high-quality care and commissioners in developing an evidence-based service.

Criteria for the Replacement of Restorations: Academy of Operative Dentistry European Section

The replacement of a restoration is one of the most common procedures in dentistry. However, the criteria for such intervention, excluding catastrophic failure and persistent discomfort and pain, continue to be the subject of considerable debate. The decision-making process remains subjective on the part of the treating clinician, while the evidence base for refurbishment and repair rather than replacement for the management of defective and failing restorations continues to grow and strengthen. This article, prepared as an Academy of Operative Dentistry European Section consensus publication, reviews existing criteria for the replacement of restorations and encourages practitioners to shift, if not already doing so, to considering the replacement of a restoration as a last resort rather than as a prudent action to be taken if in any doubt about clinical acceptability. Further research in the area, spanning the risk assessment of defective and failing restorations and new diagnostic tools and processes, together with work to enhance the evidence base of restoration repair vs replacement, would be of immense value.

Growth Factor Liberation and DPSC Response Following Dentine Conditioning

Liberation of the sequestrated bioactive molecules from dentine by the action of applied dental materials has been proposed as an important mechanism in inducing a dentinogenic response in teeth with viable pulps. Although adhesive restorations and dentine-bonding procedures are routinely practiced, clinical protocols to improve pulp protection and dentine regeneration are not currently driven by biological knowledge. This study investigated the effect of dentine (powder and slice) conditioning by etchants/conditioners relevant to adhesive restorative systems on growth factor solubilization and odontoblast-like cell differentiation of human dental pulp progenitor cells (DPSCs). The agents included ethylenediaminetetraacetic acid (EDTA; 10%, pH 7.2), phosphoric acid (37%, pH <1), citric acid (10%, pH 1.5), and polyacrylic acid (25%, pH 3.9). Growth factors were detected in dentine matrix extracts drawn by EDTA, phosphoric acid, and citric acid from powdered dentine. The dentine matrix extracts were shown to be bioactive, capable of stimulating odontogenic/osteogenic differentiation as observed by gene expression and phenotypic changes in DPSCs cultured in monolayer on plastic. Polyacrylic acid failed to solubilize proteins from powdered dentine and was therefore considered ineffective in triggering a growth factor-mediated response in cells. The study went on to investigate the effect of conditioning dentine slices on growth factor liberation and DPSC behavior. Conditioning by EDTA, phosphoric acid, and citric acid exposed growth factors on dentine and triggered an upregulation in genes associated with mineralized differentiation, osteopontin, and alkaline phosphatase in DPSCs cultured on dentine. The cells demonstrated odontoblast-like appearances with elongated bodies and long extracellular processes extending on dentine surface. However, phosphoric acid-treated dentine appeared strikingly less populated with cells, suggesting a detrimental impact on cell attachment and growth when conditioning by this agent. These findings take crucial steps in informing clinical practice on dentine-conditioning protocols as far as treatment of operatively exposed dentine in teeth with vital pulps is concerned.

How is research publishing going to progress in the next 20 years? Transcription of session for editors, associate editors, publishers and others with an interest in scientific publishing held at IADR meeting in Seattle on Wednesday, 20 March 2013

On March 20th 2013, a one-hour session for Editors, Associate Editors, Publishers and others with an interest in scientific publishing was held at the IADR International Session in Seattle. Organised by Kenneth Eaton and Chris Lynch (Chair and Secretary, respectively, of the British Dental Editors Forum), the meeting sought to bring together leading international experts in dental publishing, as well as authors, reviewers and students engaged in research. The meeting was an overwhelming success, with more than 100 attendees. A panel involving four leading dental editors led a discussion on anticipated developments in publishing dental research with much involvement and contribution from audience members. This was the third such meeting held at the IADR for Editors, Associate Editors, Publishers and others with an interest in scientific publishing. A follow up session will take place in Cape Town on 25 June 2014 as part of the annual IADR meeting. The transcript of the meeting is reproduced in this article. Where possible speakers are identified by name. At the first time of mention their role/ position is also stated, thereafter only their name appears. We are grateful to Stephen Hancocks Ltd for their generous sponsorship of this event. For those who were not able to attend the authors hope this article gives a flavour of the discussions and will encourage colleagues to attend future events. Involvement is open to Editors, Associate Editors, Publishers and others with an interest in scientific publishing. It is a very open group and all those with an interest will be welcome to join in.

Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study--the LIFE study

STUDY QUESTION

Are women's stress levels prospectively associated with fecundity and infertility?

SUMMARY ANSWER

Higher levels of stress as measured by salivary alpha-amylase are associated with a longer time-to-pregnancy (TTP) and an increased risk of infertility.

WHAT IS KNOWN ALREADY

Data suggest that stress and reproduction are interrelated; however, the directionality of that association is unclear.

STUDY DESIGN, SIZE, DURATION

In 2005-2009, we enrolled 501 couples in a prospective cohort study with preconception enrollment at two research sites (Michigan and Texas, USA). Couples were followed for up to 12 months as they tried to conceive and through pregnancy if it occurred. A total of 401 (80%) couples completed the study protocol and 373 (93%) had complete data available for this analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Enrolled women collected saliva the morning following enrollment and then the morning following their first observed study menses for the measurement of cortisol and alpha-amylase, which are biomarkers of stress. TTP was measured in cycles. Covariate data were captured on both a baseline questionnaire and daily journals.

MAIN RESULTS AND THE ROLE OF CHANCE

Among the 401 (80%) women who completed the protocol, 347 (87%) became pregnant and 54 (13%) did not. After adjustment for female age, race, income, and use of alcohol, caffeine and cigarettes while trying to conceive, women in the highest tertile of alpha-amylase exhibited a 29% reduction in fecundity (longer TTP) compared with women in the lowest tertile [fecundability odds ratios (FORs) = 0.71; 95% confidence interval (CI) = (0.51, 1.00); P < 0.05]. This reduction in fecundity translated into a >2-fold increased risk of infertility among these women [relative risk (RR) = 2.07; 95% CI = (1.04, 4.11)]. In contrast, we found no association between salivary cortisol and fecundability.

LIMITATIONS, REASONS FOR CAUTION

Due to fiscal and logistical concerns, we were unable to collect repeated saliva samples and perceived stress questionnaire data throughout the duration of follow-up. Therefore, we were unable to examine whether stress levels increased as women continued to fail to get pregnant. Our ability to control for potential confounders using time-varying data from the daily journals, however, minimizes residual confounding.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first US study to demonstrate a prospective association between salivary stress biomarkers and TTP, and the first in the world to observe an association with infertility.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts #N01-HD-3-3355, N01-HD-3-3356, N01-HD-3358). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

In Vitro Evaluation of the Effect of Different Endodontic Sealers on Retentive Strength of Fiber Posts

Purpose

There is limited information in the literature regarding the effect of different endodontic sealers on the bond strength of fiber posts luted with core buildup materials. The purpose of this study was to evaluate the effect of three different root canal sealers on the retentive strength of prefabricated fiber posts luted with a composite resin cement.

Materials and Methods

Fifty-four extracted single-rooted mandibular premolar teeth were prepared and randomly divided into three groups. The first two groups were obturated with gutta-percha and one of two eugenol-based root canal sealers (Endofil, Tubli-Seal). The third group (control) was obturated with gutta-percha and a resin-based root canal sealer (AH26). Prefabricated fiber posts were luted into the prepared post spaces with a composite resin cement (Multicore Flow). The pullout forces required for dislodgment of posts from their prepared post spaces were recorded. Data were collected and statistically analyzed.

Results

The AH26 group had significantly greater retentive strengths for the posts when compared with the Endofil and Tubli-Seal (eugenol-based sealers) groups (p&lt;0.0001). There was no significant difference between the means of the retentive strengths for the Endofil and Tubli-Seal groups (p=0.745).

Conclusion

The chemical formulation of root canal sealers significantly affected the retentive strength for prefabricated fiber posts luted with a resin cement. Eugenol-based sealers significantly reduced the bond strength of prefabricated fiber posts luted with resin cement.

The Management of Defective Resin Composite Restorations: Current Trends in Dental School Teaching in Japan

Aim:

The aim of this article is to investigate the contemporary teaching of the management of defective direct resin composite restorations in dental schools in Japan.

Methods:

A questionnaire relating to the teaching of the management of defective resin composite restorations was developed and e-mailed to 29 dental schools in Japan in 2010.

Results:

Completed responses were received from 19 of the 29 invited schools (response rate = 66%). Eighteen schools (95%) report that they included the teaching of repair of direct defective resin composite restorations in their dental school programs. Thirteen schools reported that they included both clinical and didactic instruction on the repair of direct resin composite restorations. Fourteen schools did not teach any mechanical roughening of the exposed resin composite restoration surface before undertaking a repair. The most commonly reported treatment was acid etching with phosphoric acid (12 schools). The most commonly taught material for completing repairs was a flowable resin composite (16 schools).

Conclusion:

The teaching of repair of defective resin composite restorations is well established within many Japanese dental schools, to a greater extent than in some other regions of the world. The impact of this teaching on subsequent clinical practices in Japan should be investigated. Furthermore, it is concluded that there is a need for much stronger leadership in operative and conservative dentistry, ideally at the global level, to resolve differences in key aspects of operative procedures such as repairs.

Teaching of direct composite restoration repair in undergraduate dental schools in the United Kingdom and Ireland

AIM

To investigate aspects of the teaching of restoration repair as a minimally invasive alternative to the replacement of defective direct composite restorations in teaching programmes in undergraduate curricula in dental schools in the United Kingdom and Ireland.

METHODS

An online questionnaire which sought information in relation to the current teaching of composite restoration repair was developed and distributed to the 17 established UK and Irish dental schools with undergraduate teaching programmes in Spring 2010.

RESULTS

Completed responses were received from all 17 schools (response rate= 100%). Fifteen schools reported that they included teaching of repair techniques for defective direct composite restorations in their programme. Of the two remaining schools, one indicated that it would introduce teaching of repair techniques during the next five years. The most common indication for a composite repair was that of 'tooth substance preservation' (15 schools). The defects in restorations considered appropriate for repair rather than replacement by the largest number of schools included partial loss of restoration (13 schools) and marginal defects (12 schools). The most commonly taught surface treatment when performing a repair was mechanical roughening of the existing composite with removal of the surface layer (14 schools). Thirteen schools taught etching and the application of an adhesive bonding agent to the prepared surfaces, while the most commonly taught material for completing the repair was a hybrid composite resin (12 schools). Popular finishing implements included diamond finishing instruments (13 schools) and finishing discs (11 schools).

CONCLUSION

Not withstanding reluctance amongst general dental practitioners, the teaching of repair of a defective composite restoration, rather than total restoration replacement, is firmly established within UK and Irish dental school programmes. Repair techniques have clear advantages for patients, not least including a minimally invasive approach to treatment and avoidance of unnecessary loss of tooth tissue and pulpal damage. Dental practitioners should look more to repair techniques when managing defective composite restorations and clinical dental teachers should continue to research and refine composite repair techniques.

Is there a correlation between dental caries and body mass index-for-age among adolescents in Iran?

AIM

Obesity in adolescents is a public health problem and is steadily increasing in many countries. The aim of this study was to investigate the association between age-and gender-specific body mass index (BMI-for-age) and dental caries among adolescents aged 12 -15 years in Rafsanjan, Iran.

MATERIALS AND METHODS

Following ethical approval, 747 students aged 12-15 years were randomly selected from 12 state and private secondary schools in Rafsanjan, Iran. The DMFT index (following World Health Organization criteria) was used to assess the subjects' previous and existing dental caries experience. The BMI (Body Mass Index) percentile was calculated using BMI-for-age criteria as underweight (< 5th percent), normal-weight (5th-85th percent), at risk of being overweight (> 85th and < 95th percent) and overweight (> or = 95th percent).

RESULTS

Of 353 males and 394 females examined, 7.5% were underweight, 72.8% were normal-weight, 13.8% were at risk of being overweight, and 5.9% were overweight. The mean DMFT was 2.83. There was no significant difference between DMFT scores amongst the BMI-for-age groups (underweight = 2.91, normal-weight = 2.92, at risk of overweight = 2.54, overweight = 2.34, p > 0.05). However, males were more likely to have caries than females (11% of males were caries-free, in comparison to 20.6% of females; p < 0.05).

CONCLUSION

Almost one in five adolescents (19.7%) examined were deemed to be at risk of being overweight, or were classified as overweight. There was no association between DMFT scores and BMI-for-age scores.

Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork

AIM

The aim of this study was to describe the self-reported confidence levels of final year students at the School of Dentistry, Cardiff University and at the University Dental School & Hospital, Cork, Ireland in performing a variety of dental procedures commonly completed in primary dental care settings.

METHOD

A questionnaire was distributed to 61 final year students at Cardiff and 34 final year students at Cork. Information requested related to the respondents confidence in performing a variety of routine clinical tasks, using a five-point scale (1=very little confidence, 5=very confident). Comparisons were made between the two schools, gender of the respondent, and whether or not a student intended completing a year of vocational training after graduation.

RESULTS

A response rate of 74% was achieved (n=70). The greatest self-reported confidence scores were for 'scale and polish' (4.61), fissure sealants (4.54) and delivery of oral hygiene instruction (4.51). Areas with the least confidence were placement of stainless steel crowns (2.83), vital tooth bleaching (2.39) and surgical extractions (2.26). Students at Cardiff were more confident than those at Cork in performing simple extractions (Cardiff: 4.31; Cork: 3.76) and surgical extractions (Cardiff: 2.61; Cork: 1.88), whilst students in Cork were more confident in caries diagnosis (Cork: 4.24; Cardiff: 3.89) fissure sealing (Cork: 4.76; Cardiff: 4.33) and placement of preventive resin restorations (Cork: 4.68; Cardiff: 4.22).

CONCLUSION

  Final year students at Cardiff and Cork were most confident in simpler procedures and procedures in which they had had most clinical experience. They were least confident in more complex procedures and procedures in which they had the least clinical experience. Increased clinical time in complex procedures may help in increasing final year students' confidence in those areas.

Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth

The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmö: n=27). Ninety-three per cent of Malmö students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmö students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.

Attitudes of final-year dental students to bleaching of vital and non-vital teeth in Cardiff, Cork, and Malmö

The aim of this study was to determine attitudes of final-year dental students in Cardiff, Cork and Malmö towards tooth whitening. Following receipt of ethical approval, pre-piloted questionnaires were distributed to final-year dental students in Cork, Cardiff, and Malmö as close as possible to graduation. The questionnaire sought information relating to various opinions and attitudes towards the use of bleaching techniques including safety of bleaching, confidence in the provision of bleaching, recommendations to patients, teaching received, awareness of restrictions on the use of bleaching products and management of simulated clinical scenarios. Eighty three per cent (n = 116) of questionnaires were returned. Cork dental students had the most didactic teaching (2-h vital, 1-h non-vital bleaching) compared to Cardiff or Malmö students (0 h each). More Cork students regarded bleaching as safe (76%, n = 28) than Cardiff (70%, n = 32) or Malmö (36%, n = 12) students. More than 50% of Cork students feel they know enough about bleaching to provide it in practice, significantly more than Cardiff (< 25%) or Malmö (< 25%) students. The majority of students would provide vital bleaching after qualification (100% (n = 37) Cork; 82% (n = 27) Malmö; 76% (n = 35) Cardiff). In simulated clinical scenarios, more Cork students would propose bleaching treatments (89%n = 33) than Malmö (64%n = 21) or Cardiff (48%n= 22) students. Variations exist in the attitudes and approaches of three European dental schools towards bleaching. Dental students need to be best prepared to meet the needs of their future patients.

Concurrent validity of the parent-completed Ages and Stages Questionnaires, 2nd Ed. with the Bayley Scales of Infant Development II in a low-risk sample

Abstract Background This study assessed the concurrent validity of the Ages and Stages Questionnaire (ASQ) compared with Bayley Scales of Infant Development II (BSID II) amongst children aged 24 months. Methods Data were collected from 53 infants and mothers who participated in the New York State Angler Cohort Child Development Study. Parents completed the 24-month ASQ to assess communication, personal-social, problem-solving ability, and fine and gross motor control. The BSID II was administered by a clinical psychologist at the 24-month home visit for cognitive and psychomotor assessment. The ASQ was scored using age-specific norms of <2 SDs below any domain mean to define failure. A BSID II score of <85 indicated mild or severe delay, while a score of <70 suggested a severe delay. Results Scores on the ASQ communication and personal-social domains were moderately correlated with the BSID II Mental Scale (R= 0.52, P < 0.001; R= 0.45, P < 0.01) and ASQ gross motor with the BSID II Motor Scale (R= 0.46, P < 0.01), whereas ASQ problem-solving and fine motor domains were not significantly correlated with BSID II scores. The ASQ had a sensitivity of 100% and specificity of 87% at 24 months (n= 40) for severely delayed status. Conclusions Results suggest the ASQs provide a simple, valid, and cost-effective method for clinicians and field-based researchers to reduce the number of standardized assessments required to identify developmentally delayed infants at age 24 months. Future studies should further assess the validity of the ASQs in larger, more diverse populations of infants.

Endodontic treatment completion following emergency pulpectomy

AIM

Emergency pulpectomy is frequently performed to relieve pain experienced by patients following acute episodes of endodontic pain, or to limit the risks of infection or possible root resorption following traumatic pulpal exposures. The aim of this study was to examine subsequent patient attendance for completion of root canal treatment following pulpectomy procedures in a dental emergency unit.

METHODS

The treatment records of 574 patients who had each received an emergency pulpectomy at the Casualty Clinic of the University Dental School and Hospital, Cork, Ireland were reviewed. The influence of age, gender, etiology, tooth type, and month in which the pulpectomy was performed on subsequent completion of endodontic treatment was examined.

RESULTS

Of 574 patients, 39% (n = 224) returned to have endodontic treatment completed, 11% (n = 63) returned to have the tooth extracted, and 50% (n = 287) did not return for completion of the endodontic treatment. Cases were monitored up to five years following pulpectomy. Using a multinomial regression model, tooth type, etiology, and month in which the treatment was performed were found to be statistically significant predictors (p < 0.05) of endodontic treatment completion in the Cork University Dental School and Hospital.

CONCLUSIONS

Proper patient selection and pre-treatment counseling are important considerations when planning emergency pulpectomies to avoid inappropriate use of resources and manpower.

Embedding implant dentistry into the undergraduate dental curriculum

This article represents the consensus from a meeting of the British Society of Prosthetic Dentistry's Education Group which met to discuss implant dentistry at the undergraduate student level. The consensus recognises the need to embed the teaching of implant supported prostheses if such a treatment modality is to be widely practised after graduation. This short article makes some recommendations as well as detailing some challenges and barriers that need to be overcome if implant dentistry is to be successfully embedded in an undergraduate dental curriculum.

Student perspectives and opinions on their experience at an undergraduate outreach dental teaching centre at Cardiff: a 5-year study

AIM

Outreach teaching is now regarded as a desirable component of undergraduate dental teaching programmes in the UK. A purpose-built undergraduate dental outreach-training centre was opened in Cardiff in 2002. The aim of this paper is to report student perspectives and opinions on their experience at this unit over a 5-year period.

METHODS

Final year dental students at Cardiff University were invited to report their comments on the St David's Primary Care Unit at various times during their placement there. Information was recorded for undergraduate students who commenced final year in 2003, 2004, 2005, 2006 and 2007 (n = 257).

RESULTS

After 1 year, the most common favourable aspects reported by students included the availability of a suitably trained nurse for all procedures (n = 191), ready access to helpful/approachable teaching staff (n = 145), and closeness of learning experience to subsequent practice (n = 122). Many students commented on their growing confidence in their own abilities whilst in the unit.

CONCLUSION

Overwhelmingly, students reported their enthusiasm for training in an outreach teaching unit, preferring it to traditional dental school environments. Inherent in the comments recorded for each student was a sense of growing confidence in their abilities and development of reflective practice. Further work is needed to identify the impact of this form of dental student training on subsequent practices in Vocational Training and independent clinical careers.

Effect of pre-heating on the viscosity and microhardness of a resin composite

The effect of pre-heating resin composite on pre-cured viscosity and post-cured surface hardness was evaluated. Groups of uncured specimens were heated to 60 degrees C and compared with control groups (24 degrees C) with respect to viscosity and surface hardness. Mean (SD) viscosities of the pre-heated specimens (n = 15) were in the range of 285 (13)-377 (11) (Pa) compared with 642 (35)-800 (23) (Pa) at ambient temperature. There was a statistically significant difference between the two groups (P < 0.001). Mean (SD) Vickers microhardness (VHN) of the pre-heated group (n = 15) was 68.6 (2.3) for the top surface and 68.7 (1.8) for the bottom surface measured at 24 h post curing (specimen thickness = 1.5 mm). The corresponding values for the room temperature group were 60.6 (1.4) and 59.0 (3.5). There was a statistically significant difference between corresponding measurements taken at the top and bottom for the pre-heated and room temperature groups (P < 0.001). There was no significant difference between top and bottom measurements within each group. Pre-heating resin composite reduces its pre-cured viscosity and enhances its subsequent surface hardness. These effects may translate as easier placement together with an increased degree of polymerization and depth-of-cure.

Prosthodontic rehabilitation of hypophosphatasia using dental implants: a review of the literature and two case reports

There are reports in the literature of the various dental features of hypophosphatasia, especially where it affects the deciduous dentition. The descriptions include both the manifestations of the disorder and the subsequent patterns of tooth loss. There are fewer descriptions of the effects of hypophosphatasia on the permanent dentition and little information on the subsequent prosthodontic management of these patients, particularly in relation to the use of dental implants. The aim of this paper was to review the literature on the dental effects of hypophosphatasia, present two cases and describe how one of those patients, a young adult, was successfully rehabilitated using dental implants. That latter patient's pattern of tooth loss as well as some histological and scanning electron microscopic findings of root cementum from the other case is also described.

Duties and training of dental nurses: how do Irish practices conform to European standards?

AIM

The dental nurse is a key member of the dental team, having an important role in the delivery of oral healthcare. Despite this, there is considerable variation throughout Europe in relation to the level of training, permitted duties, and statutory registration of dental nurses. The purpose of this paper is to describe the opinions and attitudes of dental nurses to their roles and suitability of training in one European member state, Ireland, where statutory registration has recently been introduced.

METHOD

A postal questionnaire was sent to 150 dental practitioners selected from the Irish Register of Dentists. The dentists were asked to distribute questionnaire to dental nurse(s) working in their practice. Information sought from the dental nurses included their employment setting, the nature of their employment, their level of training, additional qualifications held, their views on the key duties and responsibilities of a dental nurse, and the appropriate duration and content of a dental nurse training programme.

RESULTS

Replies were received from 96 dental nurses (response rate = 64%). Fifty-five percent of respondents (n = 53) were employed in private practice, 39% (n = 37) were employed in the Health Board Dental Service, and 6% (n = 6) were employed in a dental hospital. Two thirds of respondents (n = 62) had been employed as dental nurses for more than five years. Eighty-six percent of respondents (n = 83) were in full-time employment. Seventy-three percent of respondents (n = 70) held a recognised dental nurse qualification. Sixty-five percent of respondents (n = 70) who held a dental nurse qualification felt that the appropriate duration of a dental nurse training programme was one year or less. Thirty-two percent of respondents (n = 30) had completed additional training in practice management, administration or computer skills. Ninety-five percent of respondents (n = 91) were interested in attending continuing education courses. Eighty-five percent of respondents (n = 82) felt that assistance at the administration of local anaesthetics was a key duty/responsibility for dental nurses, while only 20% of respondents (n = 19) felt that infection control procedures was a key duty.

CONCLUSIONS

Within the group of dental nurses surveyed, there was a lack of clarity surrounding their perception of their key duties. This could present challenges to the effective delivery of oral healthcare regimens within Ireland. Further investigation of this situation in other European countries is indicated.

Attitudes and use of rubber dam by Irish general dental practitioners

AIM

To investigate the attitudes towards and use of rubber dam by Irish general dental practitioners.

METHODOLOGY

A pre-piloted questionnaire was distributed amongst a group of 600 dentists randomly selected from the Irish Register of Dentists. Replies from dentists working in specialist practice or the hospital dental service were excluded. Dentists were surveyed in relation to their use of rubber dam during a variety of operative and root canal treatments, as well as their attitudes to the use of rubber dam in dental practice.

RESULTS

A total of 300 replies were considered from a total of 324 that were received. Seventy-seven per cent of respondents (n=231) worked in general dental practice and 23% (n=69) worked in the Irish Health Board/Community Dental Service. Rubber dam was 'never' used by 77% of respondents (n=228) when placing amalgam restorations in posterior teeth, 52% (n=147) when placing composite restorations in posterior teeth, and 59% (n=177) when placing composite restorations in anterior teeth. Rubber dam was 'never' used by 39% of respondents (n=114) when performing root canal treatment on anterior teeth; 32% (n = 84) when performing root canal treatment on premolar teeth; and 26% (n=51) when performing root canal treatment on molar teeth. Fifty-seven per cent (n=171) considered rubber dam 'cumbersome and difficult to apply', and 41% (n=123) considered throat pack 'as good a prevention against inhalation of endodontic instruments as rubber dam'.

CONCLUSIONS

Whilst rubber dam is used more frequently for root canal treatment than operative treatment, its use is limited. This presents quality issues, as well as medico-legal and safety concerns for both the profession and patients.

The teaching of removable partial dentures in Ireland and the United Kingdom

AIM

The aim of this paper is to investigate methods employed for teaching removable partial dentures in dental schools in Ireland and the United kingdom.

MATERIALS AND METHODS

A questionnaire was distributed by email in May 2005 to each of the 15 dental schools with undergraduate dental degree programmes in Ireland and the UK. The questionnaire sought information relating to the preclinical and clinical teaching of removable partial dentures (both acrylic and cobalt-chromium based dentures).

RESULTS

Eleven completed questionnaires were returned. The average duration of a preclinical course in removable partial dentures was 67 hours (range = 24-200 hours). This course was directed by a senior clinical academic alone in eight schools, by a senior clinical academic in collaboration with a dental technician in two schools, and solely by a dental instructor technician in one school. The median number of cobalt-chromium and acrylic removable partial dentures provided by undergraduate dental students was 3 (range = 2-5) and 2 (range = 0-3), respectively. Four schools reported that their patient pool is not entirely satisfactory for clinical teaching of undergraduate dental students.

CONCLUSION

Variations were noted between dental schools in both the amount and content of teaching programmes. Experience gained by undergraduate students in dental schools is limited, and appears to be hampered by limited access to patients suitable for undergraduate teaching.

Pierre Fauchard: the 'father of modern dentistry'

The development of the modern practice of dentistry can be traced to the work and life of Pierre Fauchard, a French dentist who worked in the first half of the eighteenth century. Fauchard was an exceptionally gifted and talented practitioner, who introduced many innovations to dentistry. In a significant break with the tradition of the time, he shared his knowledge and techniques with colleagues, and published these in the first comprehensive dental textbook. This paper reviews his life and contribution to modern dentistry.

Quality of written communication and master impressions for fabrication of removable partial prostheses in the Kingdom of Bahrain

The aim of this study was to examine the quality of written instructions and choice of impression trays and materials for removable partial dentures (RPDs) in the Kingdom of Bahrain. All six private dental laboratories in Bahrain were contacted and invited to participate in the study. Five laboratories participated, and submitted written instructions received by them for fabrication of both acrylic (A-RPDs) and cobalt-chromium (CC-RPDs) RPDs. These were examined for evidence of selected design variables. Types of impression trays and materials used were also recorded. One hundred and thirty-one written instructions were examined. Eleven percent (n = 14) were for CC-RPDs, 89% (n = 117) for A-RPDs. All treatments were provided on a private basis. Fifty-seven percent (n =1 8) of CC-RPD instructions requested the technician to design the prosthesis, 43% (n = 6) contained a diagram and 43% (n = 6) mentioned all design variables. Seventy-nine percent (n = 92) of A-RPDs requested the technician to design the denture, and only 1% (n = 1) mentioned all design variables. Alginate impression material was most commonly used for master impressions (83% of impressions (n = 109); 85% (n = 99) of A-RPDs, and 71% (n = 10) of CC-RPDs). Master casts were poured after a minimum of 24 h. Acrylic custom trays were used in 14% (n = 19) of cases (43% (n = 6) of CC-RPDs; 13% (n = 15) of A-RPDs). The quality of written instructions to dental laboratories for the fabrication of RPDs was found to be inadequate in Kingdom of Bahrain. There was widespread use of inappropriate impression trays and materials.

Challenges to teaching posterior composites in the United Kingdom and Ireland

Recent surveys from general dental practice have found increased placement of direct composite resin restorations in occlusal (Class I) and occlusoproximal (Class II) cavities in permanent teeth by general dental practitioners. This has been matched, and possibly driven, at least in part, by the development of new composite resin materials and bonding technologies. Recent studies by the authors have found an increase in the teaching of Class I and Class II composite resin restorations in the UK, Ireland, the US, and Canada. The increased teaching in the UK and Ireland, however, was not as great as in North America, and several worrying trends were observed. The aim of this paper is to discuss these trends and related factors considered important to the necessary further development of the teaching of Class I and Class II direct composite resin restorations, let alone modern operative dentistry in general, in the UK and Ireland.

Dental school admissions in Ireland: can current selection criteria predict success?

INTRODUCTION

Entry into university education in Ireland, including dental school, is based solely on academic performance in the Leaving Certificate Examination, held at the end of formal school education. The aim of this investigation was to examine the suitability of this process for the selection of dental students in Ireland.

MATERIALS AND METHODS

Information for all dental students who entered the dental degree programme immediately following completion of the Leaving Certificate Examination at the National University of Ireland, Cork, during the years 1997-1999 was retrieved. Information was collected relating to gender, the number of times the student had attempted the Leaving Certificate Examination, their performance in this examination, the total number of marks awarded to each student at the end of the First and Final Dental Examinations, and their performance in individual modules.

RESULTS

Whilst there was a significant relationship between performance in the Leaving Certificate Examination and the First Dental Examination (correlation coefficient = 0.22, P < 0.05), this relationship could only explain 12% of the variation within the performance of students in this examination. There was no relationship between performance in the Leaving Certificate and the Final Dental Examination (correlation coefficient = 0.09, P > 0.05). There was a significant correlation between performance in the Leaving Certificate Examination and performance in seven of the 55 programme modules, all of which were pre-clinical modules, and of which five were related to basic sciences.

CONCLUSIONS

Based on the limitations of this study, the current selection process for dental students in Ireland seems to be of limited value.

Quality of root canal fillings performed by undergraduate dental students on single-rooted teeth

INTRODUCTION

Root canal therapy is an accepted and successful form of tooth conservation. Educational guidelines require dental schools to ensure that their graduates are competent on graduation at performing root canal therapy. The aim of this investigation was to assess the technical quality of root canal fillings placed by undergraduate students in single-rooted teeth.

MATERIALS AND METHODS

A total of 100 radiographs of root canal fillings placed by undergraduate students in single-rooted teeth were examined under even illumination in a darkened room using x2 magnification. These were graded as 'adequate', where the root canal filling was within 2 mm of the radiographic apex, 'under-filled', where the root canal filling was >2 mm from the radiographic apex, and 'over-filled', where the root canal filling was extruded beyond the radiographic apex. The presence of voids, fractured instruments, and root perforations were also noted.

RESULTS

All teeth were obturated with gutta-percha and sealer (Roth Cement), using a cold lateral condensation technique. Of 100 teeth, 10% (n = 10) had voids. Of the remainder, 70% (n = 63) were judged to be 'acceptable', 21% (n = 19) were 'under-filled', and 9% (n = 8) were 'over-filled'. There was no evidence of fractured instruments or root perforations in any root filling examined.

CONCLUSIONS

The quality of root canal fillings placed in single-rooted teeth by undergraduate dental students at the University Dental School and Hospital, Cork was acceptable (63% of root fillings placed in single rooted teeth were graded as 'adequate'). The probable reasons for this are multi-factorial, but may be linked to the amount of pre-clinical and clinical teaching in endodontics at the University Dental School and Hospital, Cork. It should be remembered that factors other than radiographic quality/evidence must be considered when determining the outcome of root canal therapy.

Management of the flabby ridge: using contemporary materials to solve an old problem

The presence of displaceable denture-bearing tissues often presents a difficulty when making complete dentures. Unless managed appropriately, such 'flabby ridges' adversely affect the support, retention and stability of complete dentures. Many impression techniques have been proposed to help overcome this difficulty. While these vary in approach, they are similar in their complexity, are often quite time-consuming to perform, and rely on materials not commonly in use in contemporary general dental practice. The purpose of this paper is to describe an impression technique for flabby ridges that makes use of polyvinylsiloxane impression dental materials routinely available in general dental practice.

Why do dentists struggle with removable partial denture design? An assessment of financial and educational issues

AIM

Published studies in the international dental literature illustrate that the quality of prescription and fabrication of cobalt-chromium removable partial dentures (CCRPDs) by general dental practitioners frequently fail to comply with ethical and legal requirements. The reasons cited for this in the past have broadly related to either financial or educational issues. The aim of this investigation is to determine the effect of financial and educational factors on the quality of CCRPD design and fabrication by general dental practitioners.

MATERIALS AND METHODS

This investigation was completed in two parts. (1) A pre-piloted pro-forma was distributed to a number of dental laboratories throughout the UK and Ireland. These sought information relating to the quality of written instructions for CCRPDs received by these laboratories, and details of the remunerative scheme under which they were being provided. Three categories of remunerative scheme were considered, private CCRPDs in Ireland, private CCRPDs in the UK, and CCRPDs being provided by salaried NHS practitioners. (2) A pre-piloted questionnaire was distributed to vocational dental practitioners in the UK and Ireland. This sought information relating to their attitudes, opinions, and educational and clinical experiences of CCRPD design and fabrication.

RESULTS

(1) Three hundred completed pro-formas were returned from dental laboratories, 100 of which related to each of the three remunerative schemes. Poor or no written instructions were provided in 47% (n = 47) of CCRPD cases funded privately in the UK, 46% (n = 46) of CCRPD cases funded privately in Ireland, and 50% (n = 50) of CCRPDs being provided by salaried NHS practitioners. (2) One hundred and seven completed questionnaires were returned from vocational trainees. Vocational dental practitioners had completed fewer CCRPDs during VT than in dental school (dental school: median = 4, inter-quartile range = 3 to 5; VT: median = 2, inter-quartile range = 1 to 4). One-fifth of respondents (n = 22) had not completed any CCRPDs during VT. Nine per cent of VT practices (n = 10) had a surveyor on their premises. Only 15% (n = 16) of respondents felt the time they had spent in VT had increased their confidence in the design of CCRPDs.

CONCLUSION

Financial factors did not have as significant an effect on the quality of prescription and fabrication of CCRPDs as did educational factors. Serious deficiencies in the teaching of CCRPDs during vocational training were identified.

Teaching of posterior composite resin restorations in undergraduate dental schools in Ireland and the United Kingdom

PURPOSE

The aim of this study was to investigate the current teaching of posterior composite resin restorations to undergraduate dental students in Ireland and the United Kingdom (UK). The investigation was a follow-up to a survey undertaken in 1997.

MATERIALS AND METHODS

A questionnaire was distributed by e-mail to the Heads of Departments of Restorative Dentistry/Units of Operative Dentistry in each of the 15 dental schools with undergraduate dental degree programmes in Ireland and the UK. The questionnaire sought information relating to the teaching of posterior composite resin restorations in each dental school.

RESULTS

Fifteen completed questionnaires were returned (response rate = 100%). All schools (n = 15) taught the placement of composite resin restorations in occlusal cavities, 14 schools taught composite resin placement in two-surface occlusoproximal cavities and nine schools taught composite resin placement in three-surface occlusoproximal cavities. Respondents anticipated that the amount of preclinical teaching of posterior composite resin placement will increase twofold over the next 5 years, whilst the corresponding teaching of amalgam will fall to two-thirds its current level. Variation was found between dental schools in the teaching of the principles of cavity design, contraindications to placement, indications for lining and basing techniques, matrix and wedging techniques, and the use of curing lights.

CONCLUSIONS

The amount of teaching of posterior composite resin restorations in undergraduate dental schools in Ireland and the UK has increased since the time of a previous survey in 1997. Composite resin may soon equal or overtake amalgam as the material of choice when restoring posterior cavities in Irish and UK dental schools. There was, however, much variation in the nature and extent of the teaching and the techniques taught.