Experienced Dentists Research Articles

Deep learning for caries lesion detection in near-infrared light transillumination images: A pilot study

ObjectivesIn this pilot study, we applied deep convolutional neural networks (CNNs) to detect caries lesions in Near-Infrared-Light Transillumination (NILT) images. Methods226 extracted posterior permanent human teeth (113 premolars, 113 molars) were allocated to groups of 2 + 2 teeth, and mounted in a pilot-tested diagnostic model in a dummy head. NILT images of single-tooth-segments were generated using DIAGNOcam (KaVo, Biberach). For each segment (on average 435 × 407 × 3 pixels), occlusal and/or proximal caries lesions were annotated by two experienced dentists using an in-house developed digital annotation tool. The pixel-based annotations were translated into binary class levels. We trained two state-of-the-art CNNs (Resnet18, Resnext50) and validated them via 10-fold cross validation. During the training process, we applied data augmentation (random resizing, rotations and flipping) and one-cycle-learning rate policy, setting the minimum and maximum learning rates to 10−5 and 10-3, respectively. Metrics for model performance were the area-under-the-receiver-operating-characteristics-curve (AUC), sensitivity, specificity, and positive/negative predictive values (PPV/NPV). Feature visualization was additionally applied to assess if the CNNs built on features dentists would also use. ResultsThe tooth-level prevalence of caries lesions was 41%. The two models performed similar on predicting caries on tooth segments of NILT images. The marginal better model with respect to AUC was Resnext50, where we retrained the last 9 network layers, using the Adam optimizer, a learning rate of 0.5 × 10−4, and a batch size of 10. The mean (95% CI) AUC was 0.74 (0.66-0.82). Sensitivity and specificity were 0.59 (0.47-0.70) and 0.76 (0.68-0.84) respectively. The resulting PPV was 0.63 (0.51-0.74), the NPV 0.73 (0.65-0.80). Visual inspection of model predictions found the model to be sensitive to areas affected by caries lesions. ConclusionsA moderately deep CNN trained on a limited amount of NILT image data showed satisfying discriminatory ability to detect caries lesions. Clinical significanceCNNs may be useful to assist NILT-based caries detection. This could be especially relevant in non-conventional dental settings, like schools, care homes or rural outpost centers.

Metal artifact reduction for practical dental computed tomography by improving interpolation-based reconstruction with deep learning.

Metal artifact is a quite common problem in diagnostic dental computed tomography (CT) images. Due to the high attenuation of heavy materials such as metal, severe global artifacts can occur in reconstructions. Typical metal artifact reduction (MAR) techniques segment out the metal regions and estimate the corrupted projection data by various interpolation methods. However, interpolations are not accurate and introduce new artifacts or even deform the teeth in the reconstructed image. This work presents a new strategy to take advantage of the power of deep learning for metal artifact reduction. The analysis first uses coarse reconstructions from simulated locally interpolated data affected by metal fillings as a starting point. A deep learning network is then trained using the simulated data and applied to practical data. Thus, an easily implemented three-step MAR method is formed: Firstly, use the acquired projection data to create a preliminary image reconstruction with linearly interpolated data for the metal-related projections. Secondly, a deep learning network is used to remove the artifacts from the linear interpolation and recover the nonmetal region information. Thirdly, the method adds the ROI reconstruction of the metal regions. The structures behind the shading artifacts in the direct filtered back-projection (FBP) reconstruction can be partially recovered by interpolation-based MAR (I-MAR) with the network further correcting for interpolation errors. The key to this method is that the linear interpolation reconstruction errors can be easily simulated to train a network and the effectiveness of the network can be easily generalized to I-MAR results in real situations. We trained a network with a simulation dataset and validated the network against a separate simulation dataset. Then, the network was tested using simulation data that did not overlap with the training/validation datasets and real patient datasets. Both tests gave encouraging results with accurate tooth structure recovery and few artifacts. The relative root mean square error and structure similarity index method indexes were significantly improved in the tests. The method was also evaluated by two experienced dentists who gave positive evaluations. This work presents a strategy to build a transferable learning from simulations to practical systems for metal artifact reduction using a supervised deeplearning method. The system transforms the MAR analyses to an interpolation-artifact reduction problem to recover structural details from the coarse interpolation reconstruction. In this way, training data from simulations with ground truth labels can easily model the similar features in real data with I-MAR as the bridge. The network can seamlessly optimize both simulations and real data. The whole method is easily implemented with little computational cost. Test results demonstrated that this is an effective MAR method applicable to practical dental CT systems.

Retrospective Analysis of Lithium Disilicate Laminate Veneers Applied by Experienced Dentists: 10-Year Results.

To report on the 10-year clinical treatment outcomes for a strictly applied clinical protocol for pressable lithium disilicate glass-ceramic laminate veneers (LDLVs) placed by two experienced dentists. A 10-year follow-up assessment of 364 LDLVs placed in 41 patients was undertaken with the clinical criteria color/esthetic match of the porcelain surface, chipping and fracture occurrence, marginal discoloration, and integrity, assessed using the modified United States Public Health Service scoring system. After 10 years, the survival rate was 97.4%. Complications occurred in 1.64% of the restorations (fractures and debonding in 0.55% and 1.09%, respectively). A strict, repeatable protocol for placing veneers with experienced dentists yielded good results.

A Survey of Common Payment Methods and Their Determinants in Dental Clinics, in Tehran, 2018.

Objective It is believed that the payment method to dentists may affect their treatment decisions. Although payment systems may enhance job satisfaction, reduce the costs, and make better treatment decisions, there is little information about how to achieve these objectives. The aim of the present study was to survey the payment methods and the related factors in dental clinics of Tehran. Materials and Methods Using the latest list published by the Iranian Ministry of Health, we visited all dental clinics located in Tehran, and used a checklist to collect the data of the type of management, geographical location of the clinic in Tehran, payment method and its amount, history of payment method changes in the last decade, relationship between the amount of payment and the position of technical supervisor dentist, any difference in the amount of payment to male and female dentists and to young and experienced dentists. Then, the relationship between the amount of payment and the above-mentioned variables was investigated. Results The governmental sector tends to use fixed salary methods and the private sector usually uses the fee-for-service (FFS) method. Geographical location, type of management, date of establishment, and having the position of technical supervisor dentist had a significant relationship with the amount of payment. The dentist’s gender and years of experience did not have any relationship with the amount of payment. Conclusion According to the results of the present study, the method and amount of payment to dentists were related to the date of clinic establishment, having the position of technical supervisor dentist, and geographical location of the clinic. These factors could be considered as the main elements in balancing costs in clinics and improving job satisfaction among dentists.

Elements of morphology: Standard terminology for the teeth and classifying genetic dental disorders.

Dental anomalies occur frequently in a number of genetic disorders and act as major signs in diagnosing these disorders. We present definitions of the most common dental signs and propose a classification usable as a diagnostic tool by dentists, clinical geneticists, and other health care providers. The definitions are part of the series Elements of Morphology and have been established after careful discussions within an international group of experienced dentists and geneticists. The classification system was elaborated in the French collaborative network "TÊTECOU" and the affiliated O-Rares reference/competence centers. The classification includes isolated and syndromic disorders with oral and dental anomalies, to which causative genes and main extraoral signs and symptoms are added. A systematic literature analysis yielded 408 entities of which a causal gene has been identified in 79%. We classified dental disorders in eight groups: dental agenesis, supernumerary teeth, dental size and/or shape, enamel, dentin, dental eruption, periodontal and gingival, and tumor-like anomalies. We aim the classification to act as a shared reference for clinical and epidemiological studies. We welcome critical evaluations of the definitions and classification and will regularly update the classification for newly recognized conditions.

A survey of prescribing practices by general dentists in Australia

BackgroundNumerous studies of dental antibiotic prescribing show that overprescribing is a worldwide occurrence. The aim of this study was to assess prescribing practices of general dentists in Australia for antibiotics, analgesics and anxiolytics and to determine the extent to which prescribing is in accordance with current guidelines.MethodsA structured questionnaire was sent to 1468 dentists in Victoria and Queensland in July–August 2018. The questionnaire covered demographics, clinical conditions where dentists prescribe antibiotics, non-clinical factors which influence prescribing, and medicines for anxiolysis and pain relief. Responses were scored using a system based on the current Australian therapeutic guidelines. Logistic regression was used to determine the relative importance of independent variables on inappropriate prescribing.ResultsThree hundred eighty-two responses were received. Overall, 55% of overprescribing of antibiotics was detected, with a range of 13–88% on a routine or occasional basis depending on the scenario. Between 16 and 27% of respondents inappropriately preferenced analgesics over anti-inflammatories for dental pain; 46% of those who prescribed anxiolytic medicines did so inappropriately, with varying regimens and choices outside the guidelines. Years of practice was the main demographic factor influencing prescribing, with recent graduates (0–5 years) generally scoring better than their colleagues for antibiotic prescribing (p < 0.05).ConclusionsFuture interventions could be directed towards the appropriate role and use of antibiotics, shortfalls in knowledge and appropriate choices of medicines for pain relief and anxiolysis. Given that the most overprescribing occurred for localised swellings (88%), this area could be focused on in continuing education as well as ensuring it is addressed in undergraduate teaching. Continuing education on the appropriate use of medicines can be targeted at more experienced dentists as well as patients, especially those who expect antibiotics instead of treatment.Trial registrationUniversity of Melbourne Human Ethics Sub-Committee; ID: 1750768.1.

ORAL MANAGEMENT OF PATIENTS WITH CANCER

The oral management of individuals affected by medical conditions, including those with a current cancerdiagnosis, is often complex and as such should be provided by either experienced dentists or dental specialists (e.g. Special Needs Dentists) with adequate training and experience. Patients with cancer needearly dental intervention as the cancer itself or its therapy may place them at increased risk of systemic andoral complications.&#x0D; In Colombia, Special Needs Dentistry (SND) has not been formally recognized as a specialty and doesnot form part of the current dental curricula suggesting a paucity of suitably qualified dentists to providecomplex oral care for oncology patients. While it is accepted that general dentists will provide the bulk ofcare to these individuals, their knowledge base is unclear. This paper aims to improve the knowledge basearound complex SND by addressing the oral complications faced by this patient cohort and how to prioritizetreatment, together with proposing a simple protocol to streamline coordination of care between the dental,allied health and medical teams, that is, through a multidisciplinary approach. It is important to acknowledgethat dentists have a role at all three levels of the multidisciplinary management of canc

Automatic reconstruction method for high-contrast panoramic image from dental cone-beam CT data

Background and objectivePanoramic images reconstructed from dental cone beam CT (CBCT) data have been effectively used in dental clinics for disease diagnosis. Panoramic images generally have low contrast because excessive non-interest tissues participate in the reconstruction, which may affect the diagnosis. In this study, we developed a fully automatic reconstruction method to improve the global and detail contrast of panoramic images. MethodsThe proposed method consists of dental arch thickness detection, image synthesis, and image enhancement. First, the dental arch thickness is detected from an axial maximum intensity projection (MIP) image generated from the axial slices containing the teeth to reduce non-interest tissues in panoramic image reconstruction. Then, a new synthesis algorithm is proposed at image synthesis stage to reduce the effect of non-interest tissues on image contrast. Finally, an image enhancement algorithm is applied to the synthesized image to improve the detail contrast of the final panoramic image. ResultsA total of 129 real clinical dental CBCT data sets were used to test the proposed method. The panoramic images generated by three methods were subjectively scored by three experienced dentists who were blinded to the generated method. The evaluation of image contrast included the maxillary, mandible, teeth, and particular region (root canal, crown reconstruction, implants, and metal brackets). The overall image contrast score revealed that the proposed method scored the highest of 11.03 ± 2.46, followed by the ray sum and x-ray methods with corresponding scores of 6.4 ± 1.65 and 5.35 ± 1.56. The results of expert subjective scoring indicated that the image contrast of the panoramic image generated by the proposed method is higher than those of existing methods. ConclusionsThe proposed method provides a quick, effective and robust solution to improve the global and detail contrast of the panoramic image generated from dental CBCT data.

Grey value contrast sensitivity of dental practitioners in function of luminance and age.

Grey value perception is important in viewing and interpreting X-ray images. It is possible that ageing decreases the number of gray values that a person can distinguish. This hypothesis was tested in a group of dental practitioners from students to experienced dentists using a 12-bit grey scale. A custom-made computer software was used based on the principle of the "just noticeable difference" (JND). Observers were shown a picture of an outer square with increasing grey value in which a smaller square of different grey value popped up in changing positions. As soon as the observers could see the difference, they clicked the inner square. The grey values were shown with a 12-bit depth in batches of 400 grey value steps. 59 dentists of 3 age groups (20-24, 25-45 and 46-70 years) participated in the study. A subgroup of 20 practitioners performed a validation test with test-retest and test in reversed grey value sequence (white to black). JND was calculated and plotted against grey value using a third-order polynomial function. These curves were compared statistically. Test-retest, also in reversed order did not yield different curves (p values between 0.79 and 0.97). Curves between different age groups showed significant differences, with older practitioners needing more contrast to accomplish the task. Contrast sensitivity showed an optimum in the darker third of the grey scale (values around 1200). Age and grey value played a significant role in grey value perception by dental practitioners.

Immediate Functional Loading: Results for the Concept of the Strategic Implant®.

Background:Immediate functional loading of one-piece dental implants has become an accepted treatment modality for fixed restorations in fully edentulous mandibles and maxillae. Nevertheless, studies regarding immediate loading procedures in extraction sites in both the jaws, as well as in segment reconstructions and single-tooth replacements, are limited.Purpose:The purpose of this study was to evaluate the presently used protocol for immediate functional loading (within maximum 3 days) of one-piece implants which are placed according to the following methods as published by the IF.Materials and Methods:This prospective cohort study included totally 87 consecutively treated patients who receive 1169 immediately loaded one-piece Strategic Implant®, supporting fixed complete-arch maxillary or mandibular metal-ceramic bridges or segment reconstructions in both the jaws. All implants were placed by one treatment provider, who delivered also the prosthetics and controlled all cases himself over the years. Data were extracted by an experienced dentist from the patient records and from panoramic X-rays. A number of patients were interviewed at the end of the observation period. Although a total of 5100 implants were placed and observed for 12 – 57 months totally (with 105 implants out of these, having failed), this article reports the detailed results only for 1169 implants which have been followed for at least 48 months.Results:Immediate functional loading of using multiple, cortically anchored basal screw implants as a support for fixed full-arch and segment prosthesis in the upper and lower jaw demonstrated a high cumulative implant survival rate after an observation period of up to 57 months. Neither hypertension nor diabetes and neither smoking nor bending of the implant's neck had an influence on the success of the implants observed in this study. Within the limits of this study (5100 Strategic Implants were observed over a period of up to 57 months), “peri-implantitis” was not observed at all.Conclusion:The treatment concept developed for the technology of the Strategic Implant® is safe and effective and it avoids bone augmentations and “peri-implantitis”.

Automatic Detection and Classification of Dental Restorations in Panoramic Radiographs

Aim/Purpose: The aim of this study was to develop a prototype of an information-generating computer tool designed to automatically map the dental restorations in a panoramic radiograph. Background: A panoramic radiograph is an external dental radiograph of the oro-maxillofacial region, obtained with minimal discomfort and significantly lower radiation dose compared to full mouth intra-oral radiographs or cone-beam computed tomography (CBCT) imaging. Currently, however, a radiologic informative report is not regularly designed for a panoramic radiograph, and the referring doctor needs to interpret the panoramic radiograph manually, according to his own judgment. Methodology: An algorithm, based on techniques of computer vision and machine learning, was developed to automatically detect and classify dental restorations in a panoramic radiograph, such as fillings, crowns, root canal treatments and implants. An experienced dentist evaluated 63 panoramic anonymized images and marked on them, manually, 316 various restorations. The images were automatically cropped to obtain a region of interest (ROI) containing only the upper and lower alveolar ridges. The algorithm automatically segmented the restorations using a local adaptive threshold. In order to improve detection of the dental restorations, morphological operations such as opening, closing and hole-filling were employed. Since each restoration is characterized by a unique shape and unique gray level distribution, 20 numerical features describing the contour and the texture were extracted in order to classify the restorations. Twenty-two different machine learning models were evaluated, using a cross-validation approach, to automatically classify the dental restorations into 9 categories. Contribution: The computer tool will provide automatic detection and classification of dental restorations, as an initial step toward automatic detection of oral pathologies in a panoramic radiograph. The use of this algorithm will aid in generating a radiologic report which includes all the information required to improve patient management and treatment outcome. Findings: The automatic cropping of the ROI in the panoramic radiographs, in order to include only the alveolar ridges, was successful in 97% of the cases. The developed algorithm for detection and classification of the dental restorations correctly detected 95% of the restorations. ‘Weighted k-NN’ was the machine-learning model that yielded the best classification rate of the dental restorations - 92%. Impact on Society: Information that will be extracted automatically from the panoramic image will provide a reliable, reproducible radiographic report, currently unavailable, which will assist the clinician as well as improve patients’ reliance on the diagnosis. Future Research: The algorithm for automatic detection and classification of dental restorations in panoramic imaging must be trained on a larger dataset to improve the results. This algorithm will then be used as a preliminary stage for automatically detecting incidental oral pathologies exhibited in the panoramic images.

The patient-dentist relationship and the future of dentistry.

The patient-dentist relationship is a delicate partnership that forms the core of dentistry. The attack on this partnership by the General Dental Council has led to gross miscarriages of justice and the emergence of defensive dentistry. This essay considers the role of a governing body, the misconduct of the GDC and the response of the profession to the injustices perpetrated. The system of NHS general dental practice is considered in terms of quality and humanity and found to be failing in quality and lacking in humanity. The paper concludes that the General Dental Council must go and that NHS general dental practice needs to be terminated. The GDC is apparently not accountable to anyone but the practice of dentistry is accountable to the dentists. The profession will need to be courageous and take action to bring about radical change. A new governing body consisting of young dentists and older more experienced dentists will establish a proper system of professional standards and care for patients. A new, dentist-controlled private system of subsidised general dental practice will be introduced using government financial support for dentistry. The patient-dentist partnership will thus be able to move into a new era of quality and humanity.

An oral and maxillofacial navigation system for implant placement with automatic identification of fiducial points.

Surgical navigation system (SNS) has been an important tool in surgery. However, the complicated and tedious manual selection of fiducial points on preoperative images for registration affects operational efficiency to large extent. In this study, an oral and maxillofacial navigation system named BeiDou-SNS with automatic identification of fiducial points was developed and demonstrated. To solve the fiducial selection problem, a novel method of automatic localization for titanium screw markers in preoperative images is proposed on the basis of a sequence of two local mean-shift segmentation including removal of metal artifacts. The operation of the BeiDou-SNS consists of the following key steps: The selection of fiducial points, the calibration of surgical instruments, and the registration of patient space and image space. Eight cases of patients with titanium screws as fiducial markers were carried out to analyze the accuracy of the automatic fiducial point localization algorithm. Finally, a complete phantom experiment of zygomatic implant placement surgery was performed to evaluate the whole performance of BeiDou-SNS. The coverage of Euclidean distances between fiducial marker positions selected automatically and those selected manually by an experienced dentist for all eight cases ranged from 0.373 to 0.847mm. Four implants were inserted into the 3D-printed model under the guide of BeiDou-SNS. And the maximal deviations between the actual and planned implant were 1.328mm and 2.326mm, respectively, for the entry and end point while the angular deviation ranged from 1.094° to 2.395°. The results demonstrate that the oral surgical navigation system with automatic identification of fiducial points can meet the requirements of the clinical surgeries.

Weight gain may affect mandibular advancement device therapy in patients with obstructive sleep apnea: a retrospective study

The aim was to analyze whether or not weight gain influences the treatment outcome of patients with obstructive sleep apnea (OSA) treated with mandibular advancement devices (MAD). As a part of a follow-up study among OSA patients treated with MAD in primary oral health care, a group of 28 patients reporting worsening of daytime or nighttime symptoms of OSA was given closer examination. Altogether, 21 subjects had a complete set of recordings and were enrolled into the study. Only three subjects had lost weight during the study period. The mean weight gain of 3.6kg ± 7.1kg was significant (p = 0.035). According to linear regression, weight gain was independently significantly associated with lower mean peripheral oxygen saturation 92.4 (SD 1.8 (% per hour) (p = 0.019)) and lowest oxygen saturation 80.1 (SD 7.2 (%) (p = 0.024)) scores. Weight gain is detrimentally associated with MAD treatment in patients with OSA. These findings suggest that regular follow-up by an experienced dentist is advisable to assess for possible worsening of OSA. Patient support to encourage weight control may be an important adjunct to MAD treatment for OSA.

In Vitro Comparison of ICDAS And DIAGNOdent Pen in The Diagnosis and Treatment Decisions of Non-Cavitated Occlusal Caries

The aim of this study was to compare the efficacy of the ICDAS and the DIAGNOdent Pen in the diagnosis of occlusal caries lesions without cavitation, and for basing treatment decisions on the results obtained. Eighty permanent molar teeth that were healthy and non-cavitated or that had an initial occlusal lesion were evaluated. All teeth were investigated using DIAGNOdent Pen and ICDAS by four examiners. Histological evaluation of teeth was performed using stereomicroscopy by a histologist and different experienced dentist. For evaluation of the data, weighted kappa values (kw), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR+) values of the tests were calculated. The diagnostic results obtained using the DIAGNOdent Pen were found to correlate better with the results obtained from histological sections than those obtained using ICDAS. When the treatment decisions of the observers depending on the results of ICDAS, and ICDAS and DIAGNOdent Pen combination were compared with the decisions made based on histological examinations, the decisions based on ICDAS and DIAGNOdent Pen combined (kw: 0.522) were more accurate than the ones based on ICDAS (kw: 0.415) alone. In conclution, professional experience is an effective factor in diagnosing occlusal caries lesions without cavitation with ICDAS and in making treatment decisions for them. DIAGNOdent Pen is sufficient in diagnosing occlusal caries lesions without cavitation.

Augmented reality surgical navigation with accurate CBCT-patient registration for dental implant placement.

It is challenging to achieve high implant accuracy in dental implant placement, because high risk tissues need to be avoided. In this study, we present an augmented reality (AR) surgical navigation with an accurate cone beam computed tomography (CBCT)-patient registration method to provide clinically desired dental implant accuracy. A registration device is used for registration between preoperative data and patient outside the patient's mouth. After registration, the registration device is worn on the patient's teeth for tracking the patient. Naked-eye 3D images of the planning path and the mandibular nerve are superimposed onto the patient in situ to form an AR scene. Simultaneously, a 3D image of the drill is overlaid accurately on the real one to guide the implant procedure. Finally, implant accuracy is evaluated postoperatively. A model experiment was performed by an experienced dentist. Totally, ten parallel pins were inserted into five 3D-printed mandible models guided by our AR navigation method and through the dentist's experience, respectively. AR-guided dental implant placement showed better results than the dentist's experience (mean target error = 1.25mm vs. 1.63mm; mean angle error = 4.03° vs. 6.10°). Experimental results indicate that the proposed method is expected to be applied in the clinic. Graphical abstract ᅟ.

In vivo imaging in the oral cavity by endoscopic optical coherence tomography.

The common way to diagnose hard and soft tissue irregularities in the oral cavity is initially the visual inspection by an experienced dentist followed by further medical examinations, such as radiological imaging and/or histopathological investigation. For the diagnosis of oral hard and soft tissues, the detection of early transformations is mostly hampered by poor visual access, low specificity of the diagnosis techniques, and/or limited feasibility of frequent screenings. Therefore, optical noninvasive diagnosis of oral tissue is promising to improve the accuracy of oral screening. Considering this demand, a rigid handheld endoscopic scanner was developed for optical coherence tomography (OCT). The novelty is the usage of a commercially near-infrared endoscope with fitting optics in combination with an established spectral-domain OCT system of our workgroup. By reaching a high spatial resolution, in vivo images of anterior and especially posterior dental and mucosal tissues were obtained from the oral cavity of two volunteers. The convincing image quality of the endoscopic OCT device is particularly obvious for the imaging of different regions of the human soft palate with highly scattering fibrous layer and capillary network within the lamina propria.

Tooth wear risk assessment and care-planning in general dental practice.

Objective To assess charting, risk assessment and treatment-planning of tooth wear between recently qualified and experienced dentists in general dental practice.Design Service evaluation.Setting Multi-setting evaluation of three mixed NHS/Private general dental practices in North-East London.Methods The clinical notes of new patient examinations on dentate adults presenting from the 1 October 2016 to 31 December 2016 were audited collecting data on tooth wear charting, risk assessment and treatment planning. Data were analysed using descriptives, chi square and logistic regressions in SPSS. Significance was inferred at p <0.05.Results Foundation dentists and experienced dentists performed 85 and 200 new patient examinations, respectively, during the evaluation period. Tooth wear was charted for 48% of those attending foundation dentists and 5% of those attending experienced dentists. Diet was assessed in 50.6% of patients examined by foundation dentists and 1.0% of patients examined by experienced dentists. Foundation dentists were more likely to chart tooth wear, risk assess and preventively manage tooth wear compared to experienced dentists (p <0.001).Conclusion This service evaluation highlights that improvements are required in recording, risk assessing and preventive treatment planning of erosive tooth wear. Experienced dentists were less likely to risk assess tooth wear and less likely to provide preventive treatment. Experienced GDPs may benefit from re-training in this area.

Current knowledge among Japanese experienced general dentists regarding prevention of infective endocarditis.

Infective endocarditis (IE), a life-threatening condition predominantly occurring in patients with underlying heart disease, is mainly caused by bacteremia induced by invasive dental treatment. However, the amount of related information shared between cardiologists and dentists appears to be inadequate. In the present study, a survey regarding prevention of IE, composed of 13 major questions, 2 of which also allowed free comments, was sent to approximately 3000 dentists belonging to a prefectural dental association in Japan. Of the 13.6% who returned the forms, more than 80% were general dentists with more than 20years of experience. Approximately, 55% of the responders reported that they had opportunities to prescribe antibiotics prior to performing treatments with risk of IE, though noted difficulties with designation of which patients with heart disease were at risk. Most of the dentists considered that oral surgery procedures have a high risk for IE, whereas less invasive procedures were considered to be not associated with the disease. Approximately, 35% selected oral amoxicillin, with a dose of 2.0g (20%) or 500mg (27%) prescribed for adults, and 50mg (10%) or 30mg (12%) per kg of body weight for children. However, the timing of the antibiotics administration varied. The present results reveal current knowledge regarding prevention of IE among general dentists in Japan, and should be valuable for construction of a protocol to establish consensus between dentists and cardiologists.

Inter- and intraexaminer reliability of bitewing radiography and near-infrared light transillumination for proximal caries detection and assessment.

The purpose of this in vitro study was to evaluate the inter- and intraexaminer reliability of digital bitewing (DBW) radiography and near-infrared light transillumination (NIRT) for proximal caries detection and assessment in posterior teeth. From a pool of 85 patients, 100 corresponding pairs of DBW and NIRT images (~1/3 healthy, ~1/3 with enamel caries and ~1/3 with dentin caries) were chosen. 12 dentists with different professional status and clinical experience repeated the evaluation in two blinded cycles. Two experienced dentists provided a reference diagnosis after analysing all images independently. Statistical analysis included the calculation of simple (κ) and weighted Kappa (wκ) values as a measure of reliability. Logistic regression with a backward elimination model was used to investigate the influence of the diagnostic method, evaluation cycle, type of tooth, and clinical experience on reliability. Altogether, inter- and intraexaminer reliability exhibited good to excellent κ and wκ values for DBW radiography (Inter: κ = 0.60/ 0.63; wκ = 0.74/0.76; Intra: κ = 0.64; wκ = 0.77) and NIRT (Inter: κ = 0.74/0.64; wκ = 0.86/0.82; Intra: κ = 0.68; wκ = 0.84). The backward elimination model revealed NIRT to be significantly more reliable than DBW radiography. This study revealed a good to excellent inter- and intraexaminer reliability for proximal caries detection using DBW and NIRT images. The logistic regression analysis revealed significantly better reliability for NIRT. Additionally, the first evaluation cycle was more reliable according to the reference diagnoses.