Australian Dental Journal Research Articles

Management of Oblique Root Fracture Using Mineral Trioxide Aggregate: A Case Report

Management of Oblique Root Fracture Using Mineral Trioxide Aggregate: A Case Report

Guest Editorial.

This Special Issue of the Australian Dental Journal coincides with an unprecedented health event in the 21st century: the COVID-19 pandemic. Given the social and economic consequences of the disease, the vivid debate about the most effective public health measures to tackle the epidemic and the global spread of the epidemic,1 people worldwide are becoming familiar with words such as ‘epidemiology’, ‘epidemic curve’, ‘fatality rate’, ‘surveillance systems’ ‘prediction’, ‘modelling’, among other. However, what is epidemiology? Epidemiology has been conceptualised as ‘the study of the occurrence and distribution of health-related events, states, and processes in specified populations, including the study of the determinants influencing such processes, and the application of this knowledge to control relevant health problems’. Two central assumptions support this definition and, therefore, Epidemiology itself: (i) the diseases, health conditions, and their determinants are not randomly distributed in a population; (ii) the knowledge of these factors has practical implications for the control and prevention of diseases and health problems.2 This Special Issue of the Australian Dental Journal is about epidemiology, more precisely about oral epidemiology, the branch of epidemiology dedicated to oral diseases and disorders its socioeconomic, behavioural and health services related factors. It describes the state of oral health and use of dental services of the Australian adult population using information from the National Study of Adult Oral Health (NSAOH) 2017–18.3 The NSAOH 2017–18 was conducted by the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide in partnership with the Australian Government Department of Health and State/Territory health departments and dental services with support from the National Health and Medical Research Council (NHMRC). This national study involved collection of interviews from over 15,000 adults across Australia, with clinical oral epidemiological examinations performed on over 5,000 people. NSAOH 2017–18 is only the third national oral examination survey of adults in Australia. It follows from the second National Survey of Adult Oral Health conducted in 2004–06,4 and the initial National Oral Health Survey of Australia 1987–88.5 The purpose of this Special Issue is to provide a descriptive ‘snapshot’ of oral health in the adult population of Australia and to describe their use of dental services. The findings provide up-to-date evidence that can contribute to the development of oral health policies and programs in Australia. Such evidence continues to be essential because oral diseases represent a considerable burden on the health of the public. This calls for information about the distribution of oral disease and provision of dental care among relevant subgroups of the Australian population. This report also includes some comparisons of results with the first two surveys, evaluating trends in oral disease and dental care that have occurred over the past 30 years. These trends provide insights into historical influences on dental care and likely trends in oral health status. The first set of papers deal with the methods involved in relation to sampling, data collection, weighting of the data and representativeness. Following these methods papers are a set of papers that describe oral health status for outcomes such as tooth loss, caries and periodontal disease. Other important oral conditions such as fluorosis and xerostomia are also presented. The final set of papers includes impacts of oral conditions, use of dental services and dental behaviours. Together the information in these papers reflects a valuable national resource that demonstrates the widespread nature of oral diseases in the Australian population, the impacts of these oral diseases, the groups within our society that suffer the greatest burden from oral diseases and the importance of access to dental services for Australians.

Introduction.

This is my first year as Chairman of the Australian Dental Research Foundation (ADRF). I have served on the Board and Executive of the Foundation since 2011, as Chairman of the Research Advisory Committee (RAC) from 2011 to 2016, and as a Member of the RAC from 2007 to 2011. As Chairman, I am grateful for the opportunity to showcase the work of our researchers in the Australian Dental Journal (ADJ) ADRF Special Research Supplement. This Supplement provides a snapshot of the completed research projects undertaken by students, researchers and academics from across the country. It provides the busy clinician reader of the ADJ with distilled insight into the efforts of the dental research community, while simultaneously disseminating the findings from these projects to industry and the wider scientific community. Not only is the Supplement an important witness to the work of our researchers and the funding provided by the Foundation to support them; it also acknowledges the individuals, industry and organisations who have supported the Foundation through named research awards and grants. This Supplement covers a wide range of material from motor impairment and oral health-related quality of life issues in children with Cerebral Palsy, through to the exomic profile of oral precancer and the genotoxic effects of alcohol-containing mouthwashes on dysplastic oral keratinocytes. The projects cover the broad areas of basic, clinical and translational research. Bereza and colleagues demonstrate that mice with a genetic mutation in EFNB1 demonstrate increased skull size, eye socket distance and nasal bone width, promoting this as a model for patients with Craniofontonasal Dysplasia. Hamlet and Ivanovski use a diabetic animal model to demonstrate that proteins associated with wound healing and the regulation of inflammation are preferentially adsorbed onto titanium with a micro-rough hydrophilic surface suggesting implants with this surface may better integrate with bone in diabetic subjects. Finally, using modern genetic methods exploring the risk for dental caries in children, Johnson and colleagues found that new bacteria associated with severe decay depended more on a child’s environment, especially diet, than on maternal influences, and that the mix of bacteria in the mouth could be changed by topical applications of disinfectant and fluoride resulting in a health-associated flora which could last as long as a year. The Board of the Foundation is indebted to the Australian Dental Journal and its Editor, Professor Mark Bartold for supporting this initiative. I am also appreciative of the work of the Chairman of the RAC, Professor Saso Ivanovski and the ADRF Services Officer, Jane Levey for assisting with its compilation. On behalf of the Board, I appreciate the opportunity to present this ADRF Special Research Supplement and its abstracts to you.

Is there a consensus on antibiotic usage for dental implant placement in healthy patients?

I read the article entitled ‘Is there a consensus on antibiotic usage for dental implant placement in healthy patients?’ by Park et al., published in the Australian Dental Journal in the March 2018 issue.1 Dr Park et al. cited an article of ours2 that was published in 2014 in a different journal (International Journal of Oral and Maxillofacial Surgery). Although we are pleased that the authors included our findings, we would like to specify some important points to clarify the results of our systematic review. Reading a properly conducted systematic review is an efficient way to become familiar with the best available research evidence for a focused clinical question. The review team might also have obtained information from the primary authors, which was not available in the original reports. The potential strength of a systematic review lies in the transparency of each phase of the synthesis process allowing the reader to focus on the merits of each decision made in compiling the information, rather than a simple contrast of one study with another as sometimes occurs in other types of reviews.3 When a systematic review does not analyse the data statistically, it is called qualitative. However, Park et al.1 did not do a statistical study and, according to them ‘due to the significant heterogeneity which was present among the studies the meta-analysis was not possible’. Nevertheless, in the results section they write a section called ‘Quantitative study results’ where at no time is the data collected in the primary studies analysed. It is worth noting that at least six published systematic revisions exist2, 4-8 in relation to this matter which makes clear the possibility of completing a quantitative analysis (meta-analysis) in spite of heterogeneity. In the study published by Park et al.,1 they comment that our study ‘has several limitations, including a retrospective design, and the lack of a placebo group with which to compare the effectiveness of antibiotics as the intervention’. From the present letter to the editor we want to specify that, as is explained in our materials and methods, the criteria of inclusion are: (1) patients subjected to dental implant surgery; (2) randomized controlled trials; (3) the presence of a control group (not receiving antibiotics or receiving placebo); (4) systemic antibiotic treatment, with specification of the type of antibiotic, the administrated dose and the duration of treatment; and (5) specification of the implant failure and postoperative infection rates. For which we have not included any retrospective study, or any study with an absence of a control group as Park et al.1 commented. On the other hand, Park et al.1 specify that their criteria for inclusion ‘were prospective human clinical trials investigating antibiotic usage during implant placement’ and nevertheless as demonstrated in Table 1 included in Park et al.1 of the 15 studies included three are retrospective. In the USA alone, more than 3 million patients have dental implants according to the American Academy of Implant Dentistry.1 In addition, 10% of all US dentists perform implants but this figure is increasing. In our study,2 the number needed to treat (NNT) to prevent one patient from having an implant failure was 48 (95% confidence interval, 31–109). These results conform to those from other studies such as those of Chrcanovic et al. (NNT = 50)7 or Lund et al. (NNT = 50),8 and other studies with lower figures such as those of Esposito et al. in 2013 (NNT = 25 years)4 and in 2010 (NNT = 33).5 Given the large number of dental implants installed each year, we consider it important to prevent implant failure as far as possible. For all of the above, we do not understand how it is possible that Park et al.1 have reached the conclusion that ‘antibiotic use at the time of surgery does not appear to play a major role in influencing the bearly incidence of prosthesis failure, implant failure, adverse events or postoperative complications’ if they have not performed a statistical analysis of the primary studies; and in the six published meta-analyses2, 4-8 they reach the opposite conclusion, specifically recommending the administration of systemic antibiotics to prevent implant failure.

Guest Editorial

Welcome to The Management of Dental Trauma, a supplement of the Australian Dental Journal. I invite all dentists – no matter whether you are a general dentist or a specialist to read this supplement as it provides an ideal opportunity for you to update your knowledge in this important area of dental practice. Dental traumatology is unique in dentistry as it spans all of the specialty disciplines – some may be involved in the early stages to provide emergency care whilst others may be involved later to provide follow-up care. Trauma also involves all age groups and all patient population groups, plus public health aspects to study its incidence, prevalence, prevention, etc. – so it is truly relevant to every dental practitioner. Although a significant number of dental trauma cases present with relatively minor injuries to a single tooth, there are also many cases that have multiple injuries to several teeth plus the soft tissues and bones. Hence, this supplement has been developed to review dental trauma from a broader approach to help readers understand the tissue responses so they can apply the principles of management to each situation. The approach was not to repeat what can be found in various textbooks and other journal papers which provide valuable information about specific injuries and their management. Dealing with dental trauma is somewhat similar to other medical emergencies. Dental practitioners should maintain their knowledge and skills to provide basic life support for a person who collapses or has an accident – we train for this regularly and keep updated with the latest recommendations so we can help others in need. Likewise, we should regularly update our knowledge and skills for dental trauma cases as they usually present as emergencies and we need to be ready to provide the best treatment possible. This supplement provides an ideal opportunity to do so. I hope you enjoy and benefit from it. Thank you to all the authors, the reviewers, the Journal's Editor, Professor Mark Bartold am, and especially to the Senior Production Editor, Helen Pontikis, for all you have done to produce this supplement.

Withdrawn: An unusual urticarial eruption: familial cold autoinflammatory syndrome

Citation: Nguyen, R., Robinson, A., Nicholls, K., Varigos, G., Dolianatis, C. (2015) Withdrawn: An unusual urticarial eruption: familial cold autoinflammatory syndrome. Australian Dental Journal, doi: 10.1111/ajd.12361 [Epub ahead of print]. Withdrawn: The following article, “An unusual urticarial eruption: familial cold autoinflammatory syndrome” by Rebecca Nguyen, Aaron Robinson, Katherine Nicholls, George Varigos and Con Dolianatis, accepted manuscript online on May 19, 2015 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn officially. This article was briefly published online under the incorrect journal due to a technical problem at the publisher. The publisher apologises for this error. “An unusual urticarial eruption: familial cold autoinflammatory syndrome” with the DOI 10.1111/ajd.12361 will be published in a future issue of the Australasian Journal of Dermatology.

The face, the future, and dental practice: how research in craniofacial biology will influence patient care

It has been a privilege to assemble a group of Australian and international researchers to produce a special issue of the Australian Dental Journal that reflects the cutting edge of research in different aspects of craniofacial biology, and also considers how these advances will influence future education and practice within dentistry. The aim of this special issue is to provide a collection of concept papers and critical reviews on key topics that cover both fundamental and applied research in craniofacial biology and to consider the clinical implications. To do this, four questions have been addressed that lead to the four sections of this issue. These are: How have we come to the present exciting position in craniofacial biology with breakthroughs over the past 50 years? What are current fundamental research topics that are helping us to understand more about craniofacial and general development, possibly leading to future clinical developments? What are the current applied research topics that will influence future clinical practice? Looking forward, what new developments in craniofacial biology may come about that will change the face of dental education and practice? The refereed papers in this special issue are grouped into the four sections that seek to respond to these demanding questions.

Diabetes, Wound Healing And Complications: Authors' Reply

We were pleased that Dr Chandu appreciated our study on dental extractions for Type 2 diabetics on oral hypoglycaemics.1 It must be noted that this study was carefully constructed so that it only included ambulance Type 2 diabetics on oral hypoglycaemics. These form the majority (95%) of all diabetics. This study was actually performed in the extraction clinic of Adelaide Dental Hospital which is a designated general practice clinic. The extractions were performed by senior dental students, supervised by junior dental house officers. Thus, this simulates conditions in an experienced general dental practice. Certainly the extraction clinic is co-located within the Oral and Maxillofacial Surgery Unit so consultants and advanced trainees in oral and maxillofacial surgery and registered nurses are readily available. No patient in our reported study required such back-up expertise. We agree that insulin dependent Type 1 and unstable Type 2 diabetics on insulin require different care. Indeed, one could make good arguments that this is a separate disease which involves a small minority of diabetics. There is an unfortunate tendency to lump all ‘diabetics’ into one category. This should not be the case. Currently readers of the Australian Dental Journal should be aware that we are doing a similar study on insulin dependent diabetics which we will report in the Journal. Watch this space.

Are Advertisements in Dental Journals Supported by an Appropriate Evidence-Base?

Dental professionals are constantly exposed to advertisements in the dental literature. These promote products, either for use in the operatory or to recommend to patients. In an era of evidence-based practice, what references are provided to support claims made by the advertisers? ObjectiveThis study aimed to determine if advertisements in four major dental journals, whose target audience is general dental practitioners, were supported by an appropriate evidence-base, readily accessible to readers. MethodsThe 2010 printed volumes of the Australian Dental Journal, British Dental Journal, Dental Update and the Journal of the American Dental Association were hand searched to identify advertisements which made a claim of clinical benefit or superiority to competing products. Advertisements were categorized according to type of product being promoted and the availability, nature and number of any supporting references was recorded. Repeated advertisements were analyzed only once. ResultsA total of 390 advertisements were identified and 369 made a claim of benefit or superiority. When the 222 duplicates of the same advertisement were removed, 147 unique advertisements remained. Of these: 54 (37%) were advertisements related to dental devices for in-surgery use; 44 (30%) for dental materials, and 27 (18%) for dentifrices/medicaments. 113 (76.9%) advertisements offered no evidential support for claims made. Of the 34 advertisements that provided evidential support, only 20 provided a complete reference that could readily be sourced by an interested reader: 15 articles in refereed journals; 5 data on file; 3 in-house studies and combinations thereof. Four references were not accessible due to incomplete referencing. Two advertisements provided evidence that was not relevant to the product being advertised. ConclusionThe majority of advertisements in the dental literature do not provide an adequate evidence-base, readily available to readers, to support the claims being made. If evidence-based practice is to be encouraged, greater emphasis on scientific referencing in advertisements is required.

Guest Editorial

It is very fitting that the Australian Dental Journal should publish this excellent and comprehensive special issue on minimum intervention dentistry, as this treatment approach can now be viewed as achieving its ‘majority’. The term ‘minimum intervention dentistry’ was first coined1 by the Adelaide University team of Tony Dawson and the late Owen Makinson in 1992,2, 3 following Adelaide author Graham Mount's 1991 paper4 on ‘minimal treatment’ of caries. As is evident, these early papers focused on the management of caries, but over the last 21 years the concept has been extended to other areas of dentistry, notably periodontics, oral pathology and oral surgery. Minimum intervention dentistry (MID) is now becoming a universally and widely practised treatment modality, especially in caries management.5-9 Kerrod Hallett and Ian Meyers, the editors of this special issue, have assembled a team of recognized experts in their various fields, with an emphasis on caries management. Andrew Brostek (Perth) and Laurie Walsh (Brisbane) write about the principles and practice of MID, Kerrod Hallett (Melbourne) discusses one of the most important elements of MID, that of caries risk assessment, and David Manton (Melbourne) discusses diagnosis of the early carious lesion. Dentistry is becoming increasingly dependent on technology transfer from other disciplines, and French author Herve Tassery describes the use of new MID technologies in caries management. Effective implementation of MID depends on the perspectives of other stakeholders in the delivery of dental care, and these are discussed by Hanny Calache (Melbourne; public health), John Kaidonis (Adelaide; academia), Ian Meyers (Brisbane; general practice, especially the management of tooth wear) and Stephen Haynes (Sydney; dental industry). This last perspective is critical, as manufacturers have a vital role in developing products which are appropriate to MID. Ivan Darby (Melbourne) writes on MID and periodontal disease risk assessment and Camile Farah (Brisbane) writes on MID and oral pathology risk assessment. I commend this special issue to all those involved in the delivery of dental care.

Plagiarism – It’s Just Not On

This is an Editorial I should not have to write but it is being written because this has been the worst year for the Australian Dental Journal with cases of detected plagiarism. Plagiarism is defined as ‘to appropriate and give out as one’s own the writings, inventions or ideas of another’ (Concise English Dictionary). It is unfortunate to report that hardly a month goes by when I do not have a case of suspected plagiarism to deal with. Two of the more notable cases were blatant and deserve comment. The first instance was where one of our readers was reading an article in another journal when they found themselves thinking that the article they were reading was familiar. So familiar because it was an almost verbatim copy of an article they had published in the Australian Dental Journal some 18 months earlier. This required intervention on my part with the journal in question and after a protracted discussion it was agreed that indeed the Australian Dental Journal article had been plagiarised and a retraction was recorded by the offending journal. The author was reprimanded not only by the journal editors but also his academic institution. This was obviously disappointing to the editors of the journal in which the plagiarised article had been published as they had no idea of the problem. Fortunately, for the Australian Dental Journal, we have the services of a commercial web-based, electronic, plagiarism checker (iThenticate; http://www.ithenticate.com) through which I run all manuscripts prior to sending them out for peer review. It never ceases to amaze me how much material is picked up by this process. It is not uncommon for submitted manuscripts to have paragraphs and even sections copied directly from other sources without due reference. The worst cases to date are an ‘original’ case report which was 75% identical to a previously published case report by different authors and an ‘original’ scientific paper claiming to be investigating a novel treatment for oral cancer which was 89% identical to a previously published paper by different authors. Of course this is not a new problem but I do think it is an increasing problem. In this day and age where competition for jobs and promotion is great, the temptation for individuals to succumb to such activities is clearly too much. While such activity is unacceptable in any journal, I fear that the Australian Dental Journal is becoming targeted due to its rising standing in the field of international dental journals. Our impact factor is now 1.496 (up from 1.22 last year) and our ISI ranking is 31 out of 74 dentistry journals compared to 41 last year. This increased ranking carries with it increased interest in publishing in our journal. To date (September 2011) we have had 505 manuscripts from 42 countries submitted to our editorial office to be considered for publication (compared to 447 at the same time last year). In the past I have written about professionalism and the need for our profession to adhere to certain standards of behaviour. By belonging to the profession of dentistry we should not forget that a standard of behaviour is needed which is not solely focused on personal best interests. The same should apply to those who choose to submit a paper for publication in a reputable journal. Personal best interests have to be put aside for the advancement of science and clinical practice. For those who choose to not play by these rules, I guarantee you will be found out and the consequences can be professionally devastating. P Mark Bartold Editor

Stanley George Kings AM

Stanley George Kings AM

Dental Implant Tourism

The article published in the Australian Dental Journal by Barrowman et al.1 reported on the advantages and disadvantages of implant tourism. The article correctly highlights the lack of accountability and regulations and this is particularly evident when complications occur. Similar cases of complications have been reported earlier.2 One of the contributing factors for the increase in the number of implant related complications is inadequate training in the prevention, recognition and treatment of complications.1, 2 The core issue is about lack of regulations in training regarding dental implants. An ever increasing number of dental implant companies which regularly come up with newer types and versions of implants has led to much competition among implant companies to sell their respective products. Unfortunately, many of the implant companies oversimplify the entire implant therapy. In many cases, a new clinician begins practising implants after attending a company sponsored one or two-day crash course in implant dentistry. Naturally, this has led to many incidents of failures in implant related therapy. It would be very difficult to learn or teach implant dentistry, especially case selection and treatment planning within one or two days. In 1997 a non-profit corporation, the Institute for Dental Implant Awareness (IDIA) was founded to provide independent, authoritative and objective information on the benefits of dental implants as an alternative treatment option for tooth replacement.3 IDIA has been aggressive in a campaign stating that the public is best served by a team approach to implant dentistry. The Institute has been critical of two or three-day courses on dental implantology which claim to teach clinicians and instantly prepare ‘implantologists’. The organization is also against over-commercialization of the field and the entry of substandard implant brands without adequate animal/clinical trials. The organization claims to increase public awareness of the benefits of dental implants and the importance of selecting a qualified team of doctors to provide treatment.3 Clearer guidelines must be established on delivery of dental implant care so that adequately trained dentists perform dental implants which will go a long way in minimizing implant related complications. At the same time, care should be taken so that guidelines should not exclude general dentists from performing basic dental implant procedures. These steps will regulate the delivery of dental implant care to patients who come as tourists as well as to native patients, benefitting all concerned.

Guest Editorial

There was little new in the field of dental materials in the first half of the 20th century, but from the 1960s the pace of new materials development began to accelerate. Materials which are ‘bioactive’, rather than being inert, are becoming more common. It is therefore an opportune time to publish a special issue of the Australian Dental Journal on dental materials. We have recruited 11 internationally recognized authors to review the materials in their field, and we would like to acknowledge their unhesitating acceptance of our invitation. Dr John McCabe and colleagues (University of Newcastle, England) analyse ‘smart’ materials, i.e. those which can interact with the oral environment. Candidate materials are often water-based, but certain metal alloys can also display smart behaviour by undergoing predictable changes in structure in response to stimuli. Dr Randy Weiner (Millis, Maryland, USA) reviews varnishes, liners and bases. The concept of lining and ‘basing’ cavities was established many years ago, but newer materials are now available. In addition, our understanding of the need for linings or bases has changed, from chemical or thermal protection of the pulp to prevention and enhancement of the cavity seal as well as their therapeutic properties. Dr Sharan Sidhu (Queen Mary University of London) reviews glass-ionomer cements (GICs). The GICs have been available for around 40 years, are useful for reasons of adhesion to tooth structure, fluoride release and being tooth-coloured, although their sensitivity to moisture, inherent opacity, long-term wear and strength are not as adequate for long-term clinical success as desired. Their clinical performance is discussed and clinical recommendations made. Dr Bart Van Meerbeek and colleagues (Katholik University of Leuven, Belgium) review the bonding of resin composite to enamel and dentine, which is important in the prosecution of minimally invasive dentistry. Both ‘etch-and-rinse’ and ‘self-etch’ systems are equally popular, and the authors analyse the clinical aspects of their use and discuss the strategies for overcoming clinical problems. Drs Richard Simonsen and Robyn Neal (University of Arizona, USA) focus on pit and fissure sealants. Despite being an underutilized preventive modality in Australia, their use provides the optimum method for the prevention of pit and fissure caries, and/or for the prevention of the progression of incipient to frank caries. Drs Nicoleta Ilie and Reinhard Hickel (Ludwig-Maximilians-University, Germany) survey the important developments in resin composites and identify the clinical implications of their advantages and disadvantages. Differences between the various types of resin composites are highlighted, and clinicians’ wishes for future developments identified. Drs Edward Hill and James Lott (University of Mississippi, USA) provide a clinically-orientated discussion of luting materials. A range of luting materials is available, including resins, glass-ionomer cements, resin-modified glass-ionomer cements, zinc phosphate, polycarboxylate, zinc oxide-eugenol and zinc oxide-non-eugenol. However, there are confusing claims for ‘universal’ use, but clinicians must have sufficient knowledge in order to choose an appropriate luting material. Drs Cecilia Goracci and Marco Ferrari (University of Siena, Italy) examine post systems, including the adhesively luted fibre-reinforced composite posts which appear to be the best alternative to conventional cast metal posts. Other currently available post materials are also reviewed. Drs Robert Kelly and Paula Benetti (University of Connecticut, USA) provide an engineering assessment of the clinical function of various ceramic materials, and review the literature on the clinical behaviour of all-ceramic systems. The choice of dental ceramics to maximize aesthetics and durability is considered. Dr Takashi Miyazaki and Yasuhiro Hotta (Showa University, Japan) discuss the use of computer-aided design/computer-aided manufacture (CAD-CAM) in dentistry, which eliminates conventional impression systems and the lost wax process. In this article the present status of CAD-CAM in the fabrication of ceramic crowns and bridges is summarized. Dr Ivan Darby (University of Melbourne, Australia) provides an overview of materials used in periodontal therapy. Products for both guided tissue and guided bone regeneration are now available, and particular emphasis will be placed on the clinical performance of those materials available in Australia.

Preface

Welcome to this special supplement of the Australian Dental Journal titled ‘Latest trends and developments in dental materials’. As for our past special supplements, this volume has been assembled with the general dental practitioner in mind but a special intent to provide a current update on dental materials for the dental profession as a whole. Dental materials is arguably the largest research area in dentistry and thus the amount of new research is overwhelming. However, in this day and age of evidence based practice it important for this new information to be distilled into a practical and understandable format. In this issue, Professors Tyas and Burrow have selected an impressive array of international experts to discuss a wide range of dental materials of relevance to everyday dental practice. On behalf of the dental profession, I would like to thank not only Professors Tyas and Burrow for their hard work in collating these papers but also record my sincere thanks to each of the authors who took the time to contribute to this volume. I am sure you will find the material presented in this supplement enlightening and informative.

The Editor’s Job – A Balancing Act

People often ask me what it’s like to be Editor of the Australian Dental Journal. My answer is that it’s a labour of love and, for the most part, it is a very enjoyable undertaking. However, it is also not only hard work but it is emotional work. Did you know that at the time of writing this editorial, 312 papers have been submitted to this journal in 2010 to be considered for publication, but only 31 have been accepted? This means that this year there have been 281 very disappointed would-be authors who have spent considerable time preparing their manuscripts only to have them returned with a “thanks but no thanks” letter. What does this mean? Is our editorial policy for what is acceptable for publication in our journal too harsh, or is it just that the material we receive is not up to standard? Personally, I think it is that the standards of the journal dictate that we can only accept high quality manuscripts of relevance to our readers and of general importance to the global dental community. This philosophy was recently vindicated by an impressive improvement in our international standing with other ISI indexed dental journals, from a rank of 54 (Impact Factor 0.945) in 2008 to 41 (Impact Factor 1.22) in 2009. While the ISI rankings, which are driven by Impact Factor, are of interest we should not lose sight of the fact that this is not the only measure of a journal’s “success”. There are other so-called measures of scientific quality such as the Eigenfactor for which our journal is ranked 47th in the dental journal listings. Again, this is a metric score which is all well and good but may not reflect other values of the journal. While it is nice to have good metric scores, the ultimate measure for me, as Editor, is the positive feedback I get from you, the readers. For this I say thank you and I hope we can continue to walk the fine line of providing what you want (papers relevant to dentistry in Australia) and what we need (good scientific rankings). Not an easy job.

Guest Editorial

Oral medicine is the dental specialty extending beyond the areas of health traditionally regarded as “dentistry” and bridging to those covered by the umbrella of “medicine”. International descriptions reflect this and oral medicine is defined as “the dental specialty placed at the interface between medicine and dentistry and is concerned with the diagnosis and management of (non-dental) pathology affecting the oral and maxillofacial region”. In Australia, oral medicine has existed comfortably within the fold of oral pathology and oral medicine over many years but this is historical and oral pathology (a diagnostic, laboratory based specialty) is now clearly a separate specialty with both specialties having defined training programmes, specialist registration requirements and career pathways. The Oral Medicine Society of Australia and New Zealand is the representative body and membership is open to general practitioners and specialists. This supplement on contemporary oral medicine is compiled as an aid to dental and medical practitioners, as well as undergraduate and postgraduate students. It presents papers provided by specialist practitioners in Australia, and the Journal gratefully acknowledges their contributions. All papers were invited and they reflect a small part of the contribution of oral medicine specialists to the oral and general health of Australian patients. It does not show the great contribution that specialists have made to science and knowledge within oral medicine over the past 50 years. Some readers will recall with gratitude the opportunity to study under scholars of the standing of Peter Reade, Ken Adkins, Ken Sutherland and Mark Jolly. The first paper in the supplement identifies papers published in the Australian Dental Journal over the past 10 years with relevance to oral medicine. It is only a thumbprint but it shows the strong activity in the discipline and the willingness of authors to publish for the Australian dental profession rather than internationally in specialty journals where access to Australian practitioners is difficult. Oral medicine is like most of the specialty areas of dental science in general practice. It provides an opportunity to enhance the routine health services to patients. It also provides the opportunity to add value to patient health with both surveillance, treatments and referrals that bridge from cautious clinical management to life-saving situations. Oral medicine specialists have a significant load of premalignant and malignant disease, and this reflects what is being seen and recognized in general practice. A single malignancy recognized in a practising lifetime is very likely a life saved. It makes all the effort worthwhile. A follow-on question examines the boundaries of responsibility of the dental practitioner and how these should be included in general dental practice. The focus of this supplement is exclusively on non-dental pathology but that does not make surveillance any different from periodontal examinations or mixed dentition analyses. The dental practitioner is in the ideal situation with a large volume of patients who attend in regular cycles for oral examination under excellent conditions not found elsewhere in health facilities. Reasonably, the current author, and many others, feel the dental practitioner should include all visible cervico-facial skin surfaces in the examination and a full examination of cervical lymph node chains. The aim is not to become an expert diagnostician but to become skilled in the recognition of abnormality and then the decision to watch, treat or refer can be made. Many practices already undertake this level of examination and it is one of the aims of this supplement to provide assistance in this “additional” level of care.

Oral medicine in Australia 2000–2010. A publications overview

Specialties within health care are often identified by the public profile provided by members within the private clinical practice arena. This is clearly important but often the real activity of a specialty discipline exists within the training institutions. This is an unseen area for most, both members of the public as well as professional colleagues, as papers reporting developments of all kinds are delivered to highly specific target audiences and publications reporting research are published in journals again targeting specific audiences. Publication in national journals is important and provides a glimpse of research activities and a wealth of clinical material in the form of reviews and case reports directed again to a specific target audience. This paper addresses the profile of oral medicine in Australia by presenting the papers published in the Australian Dental Journal within a 10-year bracket.

Preface

Welcome to this special supplement of the Australian Dental Journal titled “Oral medicine – an update to enhance dental practice”. While this volume has been assembled with the general dental practitioner in mind, its principal aims were to provide a contemporary update on oral medicine for the dental profession as a whole. New developments in this important area of dentistry are clearly founded in evidence-based practice. Accordingly, “old conditions” are given “new light” in terms of our understanding of their pathobiology and clinical management. In this context, the Guest Editor, Associate Professor Neil Savage has called on the collective experience of many senior clinicians and academics to discuss a wide range of topics of relevance to everyday dental practice. On behalf of the dental profession I would like to thank not only Associate Professor Savage for his hard work in collating these papers but also record my sincere thanks to each of the authors who took the time to contribute to this volume. I am sure you will find the material presented in this supplement enlightening and informative.

Information Overload

Did you know that there are around 180 dental journals published globally? Of these, only 54 (28%) are listed on the ISI Web of Knowledge and have a listed “impact factor”. For those of you who are not familiar with such ranking of journals, an impact factor relates to the number of times articles published in a given journal are cited in other published papers over a two-year period. It is considered a crude measure of the journal’s prestige and ranking within a given field. We have always been pleased to note that the Australian Dental Journal appears in these rankings. With this in mind I was bemused to note recently that yet another dental journal had been launched. What was even more intriguing is that it is to be published by one of the largest medical/dental publishers in the world. This particular new journal “aims to publish quality, peer reviewed original research and topical reviews on all aspects of investigative and clinical dentistry and craniofacial research, including molecular studies related to oral health and disease.” Sounds familiar to me – the only difference is that this journal “especially encourages papers from the Asia Pacific”. As if we don’t already have enough journals and papers being published, now one publisher is seeking even more in what is already a saturated market. This has led me to ponder just what is the point of more dental journals and what is the likely effect of this? Unlike most of our readers, I have access to a very wide array of scholarly journals and publications. However, not withstanding this, many journals are not easily accessible and so the usefulness of these publications and their content could be questioned. For example, the other day I was working on writing a review paper dealing with the physiological processes involved in pathological bone loss associated with periodontal disease. While this may seem like an esoteric issue for some, the point of the paper was to consider our current knowledge and how this is going to impact on current treatments and future development of drugs as adjuncts to periodontal treatment. To me, all important stuff. However, when doing the review I found a number of papers which were of potential interest but published in “obscure” or unavailable journals. This got me thinking as to what was the reason for these publications and what was their use if they cannot be widely accessed? This, together with the arrival on my desk of the announcement of a new dental journal, makes me feel that dental publishing has lost its way. Rather than consolidating what is already available and ensuring that quality, not quantity, is the modus operandi for publishing dental research (clinical and scientific) we find ourselves overwhelmed with information – 72% of which is largely inaccessible! There is no doubt that at least in the next 5–10 years this new journal will fall within the 72% as it will not be purchased by libraries and because it does not have an “impact factor” will not be listed in mainstream databases such as PubMed and ISI Web of Science. So while a new journal may satisfy, to a point, the “publish or perish” mentality of some dental researchers, the value of publishing in such a journal must remain questionable. It is therefore my belief that what we need is less dental journals – not more. P Mark BartoldEditor