General Dental Practice Research Articles

Sir Wilfred Fish (1894-1974).

Sir Wilfred Fish was one of dentistry's 'greats', shining clinically, in research, administration and teaching. This paper examines his story. However, there is no examination of his actual research and publications. That would require another publication. He was a chairman of the Dental Board of the UK, first president of the General Dental Council and dean of the Faculty of Dental Surgery of the Royal College of Surgeons of England. His research carried out at University College London, the Royal Dental Hospital, St Mary's Hospital and the Royal College of Surgeons of England was acclaimed worldwide. His resultant Doctor of Science degree was a rarity for a dentist. All of this was achieved while running a highly successful general dental practice. He received a host of honourary degrees and diplomas at home and abroad.

A pilot study to evaluate the impact of digital imaging on the delivery of oral hygiene instruction

AimsTo determine whether personalised Oral Hygiene Advice (OHA) using an intra-oral-camera (IOC) combined with standard OHA as provided in general dental practice reduces plaque levels after 4 weeks more than the provision of standard OHA. Materials and Methods22 healthy adult participants diagnosed with gingivitis took part in this pilot parallel-designed, randomised, examiner-blind, 2x-treatment, study regarding their home-care oral hygiene habits and attitudes to oral health. An IOC-image was taken and plaque, gingival and bleeding scores were recorded. Test group participants received standard OHA with IOC-images to indicate areas for improvement, control group participants received standard OHA. Questionnaires and plaque, gingival and bleeding scores were repeated after 4 weeks. Plaque was scored from the IOC-images and scores compared to clinical plaque scores. ResultsLifestyle habits, attitudes to oral health, plaque (0.63vs0.61, control vs test) and bleeding scores (1.17vs0.96, control vs test) were similar at baseline. After 4-weeks, plaque scores improved more in test as compared to control group (39.4vs20.6%, p<0.05, while gingival and bleeding scores approached significance. There was no difference in lifestyle habits between groups, but the test group reported significantly greater confidence in adhering to their bespoke oral health plan. Agreement between the clinical and IOC plaque scores was good. ConclusionsUse of IOC further personalises the prevailing standard of oral hygiene advice and generates great patient engagement with pictorial reports to facilitate a more in-depth patient explanation of their gingival health, resulting in significant plaque reduction and improved gingival health compared to the standard OHA alone.

Present status and future directions: Managing endodontic emergencies.

Endodontic emergencies are common in both general dental practices and specialist Endodontic practices. The aim of this review is to provide an overview of endodontic emergencies. Endodontic emergencies can be a result of many different conditions of the pulp, root canal and periradicular tissues. They may occur before endodontic treatment has been started, between appointments when treatment is being performed over multiple visits, or after endodontic treatment has been completed. In the latter situation, the emergency may be very soon after the treatment or it may occur many years later, in which case it is usually a new disease process as a result of the root canal system becoming infected. An emergency can be a stressful situation for both the patient and the dentist (or endodontist) as it is usually an unexpected event. It is incumbent on dental professionals to provide timely assistance to patients who have an emergency, and it is also important to allow sufficient time to manage the situation comprehensively. Management of endodontic emergencies should follow the principles of the 3D's-Diagnosis, Definitive dental treatment and Drugs-and in that sequence. An accurate diagnosis, the first "D", is essential so the appropriate treatment can be provided. Diagnosis requires a thorough understanding of the various conditions that can cause the emergency and this can be helped by having a comprehensive classification of the various conditions. The diagnosis should also direct the clinician to the appropriate Definitive dental treatment, the second "D". Root canal treatment will not always be required as some cases can be managed conservatively. Other cases may require root canal re-treatment. The specific details of how the treatment are done can also vary, according to the diagnosis. The final "D" is Drugs-the use of drugs should also be dependent on the diagnosis and the dental treatment. Drugs should only be an adjunct following the treatment. The clinician must also differentiate between inflammation and infection in order to provide the appropriate treatment and to prescribe the appropriate medication for effective pain relief and resolution of other symptoms or signs such as swelling.

Attitude towards oral biopsy among general dental practitioners of Vadodara, a city in Western state of India

Introduction: In practice, the diagnosis of certain oral lesions must be made by biopsy. A biopsy constitutes an essential diagnostic tool in application to patients with oral pathology. However oral biopsy is not routinely performed in general dental practice. The present study aimed to explore the attitudes of General Dental Practitioners (GDPs) towards oral biopsy for diagnosis of oral lesions in Vadodara city, Gujarat, India. Methodology: A questionnaire was distributed to 200 general dental practitioners, consisting of several items addressing the socio-demographic and professional aspects and their attitudes towards oral biopsy procedures. Results: Our study showed that 73% of the GDPs do not perform a biopsy on their own. Out of which 32% of GDPs gave the reason of lack of skills and knowledge while 7% of GDPs lacked confidence in performing a biopsy on their own. 28% of the GDPs were not aware of the medium of specimen preservation. Conclusion: There is a need for better education and training of GDPs to perform oral biopsy procedures on their own and create awareness among them about the proper referral of the specimen to oral histopathological centers which will aid in accurate diagnosis of the lesions. Keywords: Oral Diagnosis; Attitudes; Biopsy; General Dental Practitioners; Oral Lesions.

Epidemiology, treatment, and recurrence of odontogenic and non-odontogenic cysts in South Sulawesi, Indonesia: A 6-year retrospective study

BackgroundDiagnosis of jaw cysts is challenging in general dental practice, and most cases are incidentally discovered through routine dental radiography. The aim of this study was to examine the epidemiology and treatment of odontogenic and non-odontogenic cysts to better understand the status of these lesions in populations in South Sulawesi, Indonesia. Material and MethodsThis retrospective study was conducted on patients treated at four different hospitals in Makassar between January 2011 and June 2017. Patients diagnosed as having odontogenic or non-odontogenic cysts were included in the study. Information on variables such as sex, age, histopathological, and anatomical distributions was collected. Statistical analyses were performed using an independent T-test and the Pearson chi-square test (p< 0.05). ResultsA total of 173 samples were collected, of which only 60 were histopathologically analyzed. The patients’ mean age was 30.3 years. The cysts occurred more frequently in women and in the anterior maxilla, followed by the posterior mandible. The radicular cyst was the most prevalent type, followed by the dentigerous cyst. Most cysts were treated with enucleation. Of the patients, 72.8% were followed up, of whom 3.2% had a recurrence and only 19.1% had complaints of clinical symptoms. ConclusionsOur findings indicate that odontogenic and non-odontogenic cysts widely vary in terms of incidence, with some exhibiting a predilection for specific ages and sites and specific sex. Knowledge of these factors could be useful for both clinicians and pathologists in the diagnosis and choice of the appropriate treatment plan. Key words:Cyst, epidemiology, odontogenic, non-odontogenic, treatment.

Attitude Towards Oral Biopsy among General Dental Practitioners of Vadodara, a City in the Western State of India

Introduction In practice, the diagnosis of certain oral lesions must be made by biopsy. A biopsy constitutes an essential diagnostic tool in application to patients with oral pathology. However oral biopsy is not routinely performed in general dental practice. The present study aimed to explore the attitudes of General Dental Practitioners (GDPs) towards oral biopsy for diagnosis of oral lesions in Vadodara city, Gujarat, India. Methodology A questionnaire was distributed to 200 general dental practitioners, consisting of several items addressing the socio-demographic and professional aspects and their attitudes towards oral biopsy procedures. Results Our study showed that 73% of the GDPs do not perform a biopsy on their own. Out of which 32% of GDPs gave the reason of lack of skills and knowledge while 7% of GDPs lacked confidence in performing a biopsy on their own. 28% of the GDPs were not aware of the medium of specimen preservation. Conclusion There is a need for better education and training of GDPs to perform oral biopsy procedures on their own and create awareness among them about the proper referral of the specimen to oral histopathological centers which will aid in accurate diagnosis of the lesions.

An ethical perspective to using bone grafts in dentistry

An ethical perspective to using bone grafts in dentistry

Importance of Dental Records: A Forensic Perspective

Dental records serve as an important source of information in medico-legal cases in general dental practice. It contains valuable diagnostic and treatment information which can aid in the identification of individuals which is otherwise difficult in the absence of personal information and fingerprints.

Necrotising periodontal diseases

Necrotising periodontal diseases (NPDs) are a group of infectious diseases that include necrotising gingivitis (NG), necrotising periodontitis (NP) and necrotising stomatitis (NS). These three clinical presentations may represent different stages of a continuum of the same disease process, with shared aetiological factors, and broadly similar initial clinical features and treatments. The term ‘ulcerative’ is no longer used in classification as ulceration is considered secondary to the gingival necrosis present. NP may result in destruction of periodontal ligament and supporting bone, while in NS, destruction progresses to deeper tissues such as the lip, cheeks and tongue. These presentations are more frequently seen in patients with HIV/AIDS or other systemic/immune compromise and, in developing countries, among those with severe malnourishment, respectively. In an Irish context, NG will represent the most common clinical form seen in general dental practice and may present as an acute condition requiring urgent management. Consequently, the current review will focus on NG. Table 1 provides an overview of the key aspects of NG.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

Predictable sedation: Safe administration of oral Midazolam and nitrous oxide gas for paediatric patients in the general dental practice

Behaviour management for anxious paediatric dental patients is challenging. Solutions include education and sedation. Various drugs have been used to effectively sedate paediatric patients during treatment. The aim of this study was to review literature on the sedation of paediatric patients. The study specifically looked at those reviews covering the combination of two sedation methods in case of more challenging paediatric patients. The study undertook a literature review focused on studies using nitrous oxide, Midazolam, or a combination of the two substances. An electronic search was done on EBSCOhost to source articles published from 1979 to 2019. A deeper form of sedation can be achieved for paediatric patients when using a combination of nitrous oxide, oxygen and a hypnotic agent such as Midazolam. Dealing with the anxiety levels of paediatric patients is a challenge for dental health providers. Two of the main strategies used to deal with anxious children are behaviour management and sedation. A critical review of journal articles on the use of nitrous oxide and oxygen in combination with Midazolam was therefore undertaken. The findings suggest that, in order to achieve a deeper form of sedation, the combination of nitrous oxide, oxygen and Midazolam works well to reduce discomfort, anxiety and/or pain in paediatric patients.

Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health

AimsTo determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated. Materials and methodsNHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months. ResultsA total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215). ConclusionsBehaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care. Clinical significancePlaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.

Compliance problems in dental infection prevention and control in England: an analysis of Care Quality Commission inspections between 2016 and 2019.

Introduction All dental practices in England must be registered with the Care Quality Commission (CQC). The CQC inspects approximately 10% of practices each year to ensure premises are safe. Compliance with infection prevention and control is assessed during inspections.Aims The aim of this study was to identify common areas of non-compliance in infection prevention and control within general dental practice in England.Materials and methods The CQC inspection reports, for all practices found not safe following an inspection, were thematically analysed for non-compliance specifically in infection prevention and control.Results Between April 2016 and March 2019, 88 practices were deemed not safe. The most common areas of non-compliance were the management of risks associated with legionella, audit and the validation of decontamination equipment.Discussion Infection prevention and control compliance requires good management and leadership. Other factors are also thought to influence compliance including cost and morality.Conclusions Identification of recurrent infection prevention and control compliance issues highlights relevant areas to all CQC dental registrants that merit greater focus.

Clinical Case of Bilateral Mandibular Auto Transplantation for Missing Bilateral First Molars: Case Report and Review of Literature

Auto transplantation is a fast and economical option when a suitable donor tooth is available for replacement of a tooth considered impossible to treat. The purpose of this case report is to describe methods used for autotransplantation and its advantages for cases with a missing bilateral mandibular firstmolar, as compared with a dental implant, removable partial denture, and other methods of prosthesis. In the present patient who underwent auto transplantation, clinical and radiographic outcomes were considered satisfactory at one and two years postoperatively. Bone healing was observed around the roots of transplanted teeth, which showed good function. In autotransplantation cases, even when the donor tooth has complete root formation, a high success rate can be achieved when the patient is properly selected and treated. Although the chance of root resorption remains because of necrotic pulp and periodontal irritation during manipulation, auto transplantation should be considered as a good treatment modality in feasible cases. Based on the present findings, even though autotransplantation is not common in general dental practice, we consider that it offers a clinically and economically viable alternative as compared to other more complicated prosthetic and dental implant treatments. The purpose of this report is to show that auto transplantation is a superior treatment method for single molar defects as compared to other prosthetic methods, as the periodontal ligament of the patient can be used and cutting adjacent teeth is avoided. In addition, it is a treatment method that can effectively utilize a wisdom tooth.

Current Novel Caries Diagnostic Technologies: Restorative Dentists' Attitude and Use Preferences.

Early detection of caries lesions is key to a successful restorative dental treatment plan. The aim of this study was to investigate the preferences and attitude of graduate restorative dentistry residents (RDRs) regarding novel caries diagnostic technologies (NCDT) and to provide a brief overview of available technologies for both specialized and general dental practice. This cross-sectional study used an online questionnaire (17 questions) concerning RDRs’ attitude, preferences, and insights regarding five available NCDTs. It was distributed among twenty RDRs at a local government dental school following a review session about NCDTs. Collected responses were analyzed statistically using one-way analysis of variance (ANOVA), chi-squared with Bonferroni correction, and Kruskal-Wallis tests at a 0.05 significance level. Sixty-five percent of RDRs reported an interest in NCDTs as a discussion topic and almost half of them were positive towards their use, however, sixty percent of respondents were hesitant to diagnose caries solely using NCDTs. Fiber-optic-transillumination (FOTI) systems were ranked the best overall and with regard to all the investigated criteria (p < 0.05). Chosen reasons for FOTI included price followed by ease of use. In general, high price rated as the most perceived reason for not choosing a given NCDT followed by low practical applicability. Meanwhile, ease of use followed by relevant application ranked as the main reported reasons to choose an NCDTs.

Managing patients with developmental co-ordination disorder in dentistry: Developing an online resource for dental professionals by a review of the literature.

To produce an online resource for dental professionals, advising them on ways to manage patients with Developmental Coordination Disorder (DCD). Literature search into the management of patients with DCD, and how to produce a high-quality leaflet using specific keywords. Using online databases, such as PubMed, the Cochrane Database and an internet search engine, an online resource in printable leaflet form was produced following a pilot readability assessment and review by those who work with individuals with DCD and a Special Care Dentistry special interest group. From the assessment tools used, the resource scored well in terms of readability and comprehension. The resource also received positive and constructive feedback from colleagues and those who work with individuals with DCD. An online resource was produced for dental professionals, although further evaluation is required on whether it will be useful to the profession. The literature review suggests the need for more research to be carried out on the association between DCD and oral health, and how dental professionals can manage those with DCD within a general dental practice.

A wider role for general dental practice?

The role of general dental practice within the NHS is limited to the direct practice of dentistry. Pandemic situations have identified the capability of dentists to take a wider role in patient care, which has been recognised by the FDI World Dental Federation. With the UK government's intention to re-structure primary healthcare to recognise lifestyle elements as the important feature of a new prevention emphasis, could and should the unique position of general dental practice play an important and integral role in promoting overall health and wellbeing?

Public Health England (PHE) and Faculty of General Dental Practice (UK) (FGDP(UK)) guidance notes for dental practitioners on the safe use of X-ray equipment 2020: an update for the dental team

PHE and FGDP(UK) co-published Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment in 2020 to encompass all relevant information to safely use and maintain radiographic equipment by dental practitioners. This guidance supersedes the first edition, previously published in 2001 by the Department of Health, and there are a number of notable changes that should be highlighted to the dental team. The document is freely available and accessible on the FGDP(UK) website and should be an essential tool to ensure the safety of the dental team, patients and the public. CPD/Clinical Relevance: Members of the dental team must acknowledge the updated guidance notes and look to incorporate these changes into their working routine to ensure good clinical practice.

Elderly Anticoagulated Patient in General Dental Practice Case Reports from everyday Life

The anticoagulated elderly patient represents a major and sometimes dreaded challenge for the dentist on a daily basis, as postoperative bleeding can lead to serious problems, especially during dental surgical procedures. Knowledge of the various anticoagulants with regard to type, mode of action and influences on dental surgical procedures is indispensable for the dentist. Using case studies from the everyday life of a dental practice in a small town in Thuringia, this problem will be examined in more detail.

The value of adult orthodontics: Do the public's willingness-to-pay values reflect the profession's?

Objective:To explore how the public and dental professionals would value an orthodontic service for adults by eliciting their willingness-to-pay (WTP), a standardised health economics technique which quantifies ‘strength of preference’ in monetary terms. Despite increasing demand, adults in the UK are only eligible for NHS orthodontic treatment if there is severe dental health or complex multidisciplinary need. Orthodontic services are provided to children aged under 18 years who are eligible by their Index of Orthodontic Treatment Need (IOTN) score. Consequently, many adults who may have a need for treatment as determined by IOTN are unable to access this service.Design:Cross-sectional survey.Setting:General dental practices in North East England and national specialists approached through the British Orthodontic Society (BOS).Participants:Public participants were recruited from general dental practices. Dentists were recruited from local dental lists and members of the BOS.Methods:Participants were asked if they would be willing to pay to see an orthodontic service extended to all adults in England with a qualifying IOTN. Clinical photographs of three malocclusions were presented and maximum WTP in additional tax per household per year was elicited using shuffled payment cards.Results:A total of 205 dentists and 206 public participants were recruited. Pairwise tests showed a statistically significant difference in WTP between the public and professionals for all malocclusions, with the public giving higher valuations. In both groups, the Class III scenario elicited a higher WTP than the class I or II malocclusion. However, when all other factors were controlled for using a regression analysis, the group (public or profession) and the other variables did not significantly influence WTP.Conclusion:The public and professionals were willing to pay for an adult orthodontic service. Due to this variability and unpredictability the allocation of healthcare resources will remain contentious.