UK General Dental Practice Research Articles

Recall intervals for oral health in primary care patients.

Recall intervals for oral health in primary care patients.

Proposal for a Strategy and Staged Return to Dentistry for UK General Dental Practice

Views from the Women of Wessex Dental Peer Review Group Meeting of 21 April 2020 summarized, on behalf of the group, by Luke and Jenny Wordley, BDS, The Borough Dental Practice in Downton ( www.theboroughdentalpractice.co.uk ).

Latex and synthetic rubber glove usage in UK general dental practice: changing trends

ObjectivesTo evaluate the current routine use of latex gloves and latex containing dental dam in UK general dental practice. MethodsA questionnaire was disseminated to 89 general dental practitioners (GDPs) in June 2017. The survey concerned their current, routine use of latex gloves and latex-containing dental dam in general dental practice. In addition, monthly sales figures of gloves classified by material, were obtained from a UK dental supply company, for 2015–2017. ResultsThe questionnaire response rate was 84 (94%), of whom 90% reported using non-latex (non-sterile examination) gloves for their routine dentistry. The majority were using nitrile gloves. All GDPs surveyed would use examination gloves for routine extractions, and 76% would use examination gloves for surgical extractions. The majority (75%) reported using non-latex dental dam. Sales of nitrile gloves were significantly higher than for latex gloves, with a continuing trend in the reduction in volume of sales of latex gloves. ConclusionThe majority of GDP's now routinely use non-latex containing gloves and dental dam in their clinical dentistry. Nitrile gloves are predominantly used. Examination gloves are used for straightforward extractions, with many practitioners also using them for minor oral surgery. Sales of latex containing gloves are continuing to decrease. Clinical significanceThe routine use of latex-containing products in UK dental practice is low and likely to reduce further, with on-going benefit for the dental practitioner, latex allergic patients and prevalence of latex allergy in the general population.

'Message to Dentist': Facilitating Communication with Dentally Anxious Children.

Dental anxiety affects children worldwide and can have negative consequences on oral health. This study aimed to evaluate a novel communication aid ‘message to dentist’ (MTD), as part of a wider cognitive behavioural therapy approach to reduce dental anxiety in young patients. Dentally anxious children, aged 9–16 years, were invited to complete the MTD proforma, before and following their course of treatment. They scored how worried they were and their anticipated pain levels on a scale of 1–10 (10 being the worst outcome). They also wrote down their coping plans and post-treatment reflections. One hundred and five children, from a UK general dental practice and a hospital clinic, were included. They had a mean age of 11.6 years, and 65% were female. There was a significant reduction in self-report worry (from 4.9 to 2.1) and anticipated pain (from 5.1 to 2.0) scores (p < 0.05, paired t-test). Many children (30%) used listening to music/audiobook as a coping strategy. Thematic analysis revealed concerns around pain, uncertainty, errors and specific procedures. The MTD proforma proved an effective means of facilitating communication between anxious children and the dental team, allowing them to identify their worries and make personalised coping plans.

Routine scale and polish for periodontal health in adults.

Routine scale and polish for periodontal health in adults.

Five Year Clinical Evaluation of Restorations Placed in a Low Shrinkage Stress Composite in UK General Dental Practices.

The low shrinkage stress material, Filtek Silorane™, demonstrated good clinical performance in the majority of parameters which were assessed at five years.

British society of prosthodontics debate on the implications of the minamata convention on mercury to dental amalgam – should our patients be worried?

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in U.K. general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools. CPD/CLINICAL RELEVANCE: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.

Local anesthetic methods used by UK NHS general dental practitioner′s for mandibular central incisor anesthesia: A study

Objective: To determine the methods of dental local anesthesia employed by UK general dental practice to anesthetize mandibular central incisor teeth and to evaluate any variations with the technique with an increase in experience. Materials and Methods: A total of 233 general dental practitioners attending postgraduate courses in dental local anesthesia and British Endodontic Society meeting completed a written questionnaire. Respondents were requested to provide information on their year and university of qualification, their location of practice and the primary local anesthetic technique employed for pulp extirpation of an inflamed vital mandibular permanent incisor. Analysis was undertaken to determine whether dentists qualified for <5 years, between 5 and 10 years and >10 years adopted different strategies. Data were analyzed by Chi-square test. Results: Buccal infiltration was employed by 110 (49.1%) practitioners. There were significant differences in choice of anesthetic method among practitioners of differing seniority. Conclusions: Buccal infiltration is the most commonly used the local anesthetic method to anesthetize the permanent mandibular central incisor teeth. More experienced practitioners, qualified >10 years, were more likely to employ a combination of methods from the outset.

Five-year clinical evaluation of zirconia-based bridges in patients in UK general dental practices

ObjectivesThis study reported the results at 5 years of fixed-fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices. Materials and methodsFour UK general dental practitioners recruited patients who required fixed bridgework and, after obtaining informed written consent, appropriate clinical and radiographic assessments were completed. The teeth were prepared and bridges constructed in accordance with the manufacturer's instructions. Each bridge was reviewed annually within 3 months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration, using modified USPHS criteria. ResultsOf the 41 bridges originally placed, 33 bridges were examined at 5 years. All Y-TZP frameworks were intact and no bridge retainers had debonded. Eight chipping fractures in the veneering ceramic were noted over the 5-year period. In five cases the patients were unaware of these and these cases were polished. Of the remaining three cases, in one a repair was attempted but was unsuccessful, but the bridge remained in satisfactory service. However, in the case involving a chipping fracture of the mesial–incisal angle of a central incisor, it was considered that replacement of the bridge was necessary. Conclusion97% (n=32) of the 33 Lava Y-TZP fixed-fixed bridges, evaluated in patients attending UK general dental practices, were found to be performing satisfactorily. Clinical relevanceThe use of Y-TZP frameworks holds promise.

A clinical evaluation of all-ceramic bridges placed in patients attending UK general dental practices: Three-year results

ObjectivesTo report the results at year three of an evaluation of fixed–fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices and luted using a self-adhesive resin-based cement. MethodsEthical approval was obtained. Four UK general dental practitioners were asked to recruit patients in accordance with the trial protocol. After obtaining informed written consent, appropriate vitality and radiographic assessments were completed and the pre-operative status of the gingival tissues noted. The teeth were prepared and bridges constructed in accordance with the manufacturer's instructions. Each bridge was reviewed annually within 3months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration. The examiners evaluated the integrity of the restoration, its anatomic form, marginal adaptation, surface quality, sensitivity, the condition of the adjacent gingivae, and the presence or absence of secondary caries. ResultsA total of 34 bridges were examined at the three-year review. All Y-TZP frameworks were intact and no bridge retainers had debonded. Two veneering ceramic chips, in total, were detected over the three-year period of observation: the patients in whom this had occurred were unconcerned. A further abutment tooth had been successfully endodontically treated, through an occlusal access cavity, in addition to the two already reported at year one. SignificanceAt year three, the 34 Lava Y-TZP fixed–fixed bridges, placed in patients attending UK general dental practices, were found to be performing satisfactorily.

Summary of: The survival of Class V restorations in general dental practice. Part 2, early failure

Objective To evaluate Class V restorations placed by UK general practitioners comparing those failing or surviving after two years, and to identify factors associated with early failure. Design Prospective longitudinal cohort multi-centre study. Setting UK general dental practices. Materials & methods Ten dentists each placed 100 Class V restorations and recorded selected clinical information at placement and recall visits. Univariate associations were assessed between recorded clinical factors and whether restorations had failed or not at two years. Multi-variable binary logistic regression was also undertaken to identify which combination of factors had a significant effect on the probability of early failure. Results At two years, 156 of 989 restorations had failed (15.8%), with 40 (4%) lost to follow-up. Univariate analysis showed a significant association between restoration failure and increasing patient age, payment method, the treating practitioner, non-carious cavities, cavities involving enamel and dentine, cavity preparation and restoration material. Multi-variable analysis indicated a higher probability of early failure associated with the practitioner, older patients, glass ionomer and flowable composite, bur-preparation and moisture contamination. Conclusions Among these practitioners, both analytic methods identified significant associations between early failure of Class V restorations and the practitioner, cavity preparation method, restoration material and patient's age.

Two year clinical evaluation of a low-shrink resin composite material in UK general dental practices

Objective A novel resin composite system, Filtek Silorane (3M ESPE) with reduced polymerization shrinkage has recently been introduced. The resin contains an oxygen-containing ring molecule (‘oxirane’) and cures via a cationic ring-opening reaction rather than a linear chain reaction associated with conventional methacrylates and results in a volumetric shrinkage of ∼1%. The purpose of this study was to review the literature on a recently introduced resin composite material, Filtek Silorane, and evaluate the clinical outcome of restorations formed in this material. Methods Filtek Silorane restorations were placed where indicated in loadbearing situations in the posterior teeth of patients attending five UK dental practices. These were evaluated, after two years, using modified USPHS criteria. Results A total of 100 restorations, of mean age 25.7 months, in 64 patients, were examined, comprised of 30 Class I and 70 Class II. All restorations were found to be present and intact, there was no secondary caries. Ninety-seven per cent of the restorations were rated optimal for anatomic form, 84% were rated optimal for marginal integrity, 77% were rated optimal for marginal discoloration, 99% were rated optimal for color match, and 93%% of the restorations were rated optimal for surface quality. No restoration was awarded a “fail” grade. No staining of the restoration surfaces was recorded and no patients complained of post-operative sensitivity. Significance It is concluded that, within the limitations of the study, the two year assessment of 100 restorations placed in Filtek Silorane has indicated satisfactory clinical performance.

State-of-the-art techniques in operative dentistry: contemporary teaching of posterior composites in UK and Irish dental schools

Advances of composite systems and their application have revolutionised the management of posterior teeth affected by caries, facilitating a minimally invasive approach. Previous surveys have indicated that the teaching of posterior composites within dental schools was developing, albeit not keeping pace with clinical evidence and the development of increasingly predictable techniques and materials. Concurrently, surveys of dental practice indicate that dental amalgam still predominates as the 'material of choice' for the restoration of posterior teeth within UK general dental practice. In light of such considerations, the aim of this study was to investigate current teaching of posterior composites in Irish and UK dental schools. An online questionnaire which sought information in relation to the current teaching of posterior composites was developed and distributed to the 17 established Irish and UK dental schools with undergraduate teaching programmes in late 2009. Completed responses were received from all 17 schools (response rate = 100%). All 17 schools taught the placement of occlusal and two-surface occlusoproximal composites in premolar and permanent molar teeth. Two schools did not teach placement of three-surface occlusoproximal composites in either premolars or molars. In their preclinical courses, ten schools taught posterior composites before teaching dental amalgams. Fifty-five percent of posterior restorations placed by dental students were of composite (range = 10-90%) and 44% amalgam (range = 10-90%), indicating an increase of 180% in the numbers of posterior composites placed over the past five years. Diversity was noted in the teaching of clinical techniques and students at different schools are trained with different composites and bonding systems. Some cause for concern was noted in the teaching of certain techniques that were not in keeping with existing best evidence, such as the teaching of transparent matrix bands and light-transmitting wedges for occluso-proximal composites (eight schools) and the teaching of bevels on the cavosurface enamel margins of both the occlusal and proximal box margins (three schools). The teaching of posterior composites in the Irish and UK dental schools has substantially increased over the last five years. Dental students in these schools often gain more experience in the placement of posterior composites than amalgam. However, practice trends indicate that a majority of GDPs continue to place amalgam in preference to composite, thereby suggesting a source of tension as current dental students emerge into the dental workforce over the coming years. There is, as a consequence, a challenge to the dental profession and its funding agencies in the UK to encourage more of a shift towards the minimally interventive use of composite systems in the restoration of posterior teeth, in particular among established practitioners.

The survival of Class V restorations in general dental practice. Part 1, baseline data

Evidence on the survival of different restorations in general practice is scarce and so to address this need, a study was designed to monitor the outcome of Class V restorations placed in UK general practices. Prospective longitudinal cohort multi-centre study. UK general dental practice. Ten UK dentists each placed 100 Class V restorations and recorded selected clinical information at placement and at recall visits on record cards. Dentists selected materials and techniques which they felt appropriate to each clinical situation. Data cards for 11 restorations were incorrectly completed or information was missing leaving 989 for analysis. The majority of restorations were placed in patients between 51 and 60 years of age, in canines or premolars (68.4%) and under private contract (63%). Composite (40.85%) and compomer (23.46%) were the most frequently placed materials overall but were not the most frequently placed restorative by some dentists. Different dentists use different methods to manage Class V lesions but each dentist tends to use one restorative material predominantly. There is a degree of overlap among practitioners in the materials which they employ, but clear preferences were displayed in the materials used and handling techniques.

Treatment planning for replacing missing teeth in UK general dental practice: current trends

The aim of this study was to examine the confidence, barriers and attitudes towards the replacement of missing teeth by general dental practitioners (GDPs). The perceived impact of the recently introduced National Health Service (NHS) contract on the provision of prosthodontic treatments was also considered. Pre-piloted postal questionnaires were mailed to 500 GDPs in Wales. Open- and closed-ended questions were utilised to establish confidence, adequacy of training and attitudes towards treatments for replacing missing teeth. Two hundred and seventeen completed questionnaires were received (response rate = 43.4%). Many respondents described themselves as 'confident' or 'very confident' in the provision of removable partial dentures (RPDs) (acrylic = 100%, metal based = 99.5%), cantilever resin-bonded bridges (94.4%) and conventional bridgework (98.6%). GDPs were 'not confident' providing fixed-fixed resin-bonded bridges (21.1%) or implants (81.4%). Financial barriers were identified to the provision of prosthodontic treatments, including comments such as "the new [National Health Service] contract does limit the treatments available". Privately funded patients were more likely to be offered a fixed bridge or implant replacement of a missing upper first molar, whereas non-privately funded patients were more likely to be offered no treatment (P < 0.01). Most respondents reported confidence at providing more routine forms of prosthodontic care such as RPDs and bridges. It appears that funding arrangements may have an impact on treatments offered to replace missing teeth, particularly under the current NHS contract.

Evidence summary: how can dietary advice to prevent dental erosion be effectively delivered in UK general dental practice?

Since August 2009, members of the newly redeveloped Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which received the most votes formed the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website. This paper details a summary of the findings of the third critical appraisal. In conclusion, the critical appraisal has identified that there is no conclusive answer to this question at present. No evidence was identified relating to the effectiveness of different strategies to apply dietary advice for the prevention of dental erosion. Given the apparently increasing prevalence of the disease in industrialised countries, this appears to be a priority area for future primary research.

A clinical evaluation of all-ceramic bridges placed in UK general dental practices: first-year results

To report the results at year one of a three-year evaluation of the performance of fixed all-ceramic bridges, constructed with a yttrium tetragonal zirconia polycrystal substructure placed in adult patients in UK general dental practices and cemented using a self-adhesive resin-based cement. Ethical approval was obtained. Four UK general dental practitioners were asked to recruit patients complying with the trial criteria and protocol. After obtaining informed written consent, appropriate vitality and radiographic assessments were completed and the pre-operative status of the gingival tissues noted. The teeth were prepared and bridges constructed using the same technician and laboratory procedures. Each bridge was reviewed within three months of the anniversary of its placement by a calibrated examiner together with the clinician who had placed the restoration. The examiners evaluated the integrity of the restoration, its anatomic form, marginal adaptation, surface quality, sensitivity, the condition of the adjacent gingivae, and the presence or absence of secondary caries. All the bridges (n = 38) examined at the first-year review were present, intact and performing well, though one small chip of the veneering porcelain was detected and in two cases an abutment tooth had been endodontically treated through an occlusal access cavity.

The potential for delegation of clinical care in general dental practice

This study describes the proportion and volume of work undertaken in primary dental care that could be delegated to hygienists and therapists. Data on treatment provision, both NHS and private, over one course of treatment for 850 consecutively attending patients at 17 dental practices, selected to be representative of a range of socioeconomic, urban and rural environments, were extracted from case records. The 850 patients attended on 2,433 occasions. Diagnostic examination accounted for 833 (34.2%) visits, while simple, intermediate and complex restorative interventions and other complex interventions accounted for 500 (20.5%), 361 (14.8%), 365 (15%) and 374 (15.4%) visits respectively. The total time required to provide the care was 42,800 minutes, of which 6,550 (15.3%) were devoted to diagnostic examinations, while 10,485 (24.5%), 7,935 (18.5%) and 11,790 (27.5%) were taken up with simple, intermediate and complex restorative care. Other complex interventions accounted for 6,040 (14.2%) minutes. Assuming that dental therapists are permitted to undertake simple and intermediate restorative interventions, they could provide 35.3% of care when number of visits is utilised as the outcome measure, but 43% of the clinical time taken to provide care. Delegation of diagnostic and treatment planning powers to dental therapists could potentially result in 69.5% of visits and 58.3% of clinical time being provided by therapists. These data imply that a considerable proportion of work in UK general dental practice could be delegated to dental hygienists and therapists.

Reinforced glass ionomer restorations

Aim To retrospectively evaluate the performance of reinforced glass ionomer restorations placed in load-bearing surfaces of posterior teeth in three UK general dental practices. Methods Inclusion criteria for the participating practitioners were that they would be able to find, in their regularly attending patients' mouths, a minimum of 30 Fuji IX restorations placed in load-bearing cavities in posterior teeth. The three practitioners who agreed to participate were given training in the methods of assessment of restorations. Presence/absence of the restoration, presence of secondary caries, anatomic form, margin adaptation, margin discolouration, surface roughness and colour match were recorded. Results Three general dental practitioners and 169 restorations in 116 patients were included in the study. Seventy-eight percent of restorations were placed in molar teeth, the remainder in premolar teeth, with 67 being Class I and 102 Class II. The mean age of restorations at examination was 25 months, ranging from five months to 56 months. Of the restorations examined, 98% (n = 166) were found to be present and intact. No secondary caries was detected clinically. Three restorations were found to have fractured. Conclusion Reinforced glass ionomer restorations placed in load-bearing situations in patients attending three dental practices in the UK were found to be performing satisfactorily at two years. Further investigations, of improved rigour, may now be indicated to more fully assess the performance of such restorations in the long term.

Two-year evaluation of restorations of a packable composite placed in UK general dental practices

The aim of this study was to assess the clinical performance at two years of 100 Solitaire 2 restorations placed in five United Kingdom dental practices by members of a practice-based research group. Restorations were assessed after two years by a trained evaluator and the dental practitioner who had placed the material, for anatomic form, marginal adaptation, surface roughness, gingival condition and the presence or absence of secondary caries. In addition, the patients completed a questionnaire requesting details of the comfort and performance of the Solitaire 2 restoration(s). A total of 88 (58 Class II and 30 Class I) restorations of Solitaire 2 placed in 49 patients (mean age 43 years) were assessed. Twelve restorations could not be evaluated because of patient unavailability for the dates of the examinations. Two Class II restorations (2%) had failed by the time of the two-year evaluation and the remaining 86 restorations were found to be intact with no secondary caries. A high percentage of optimal scores were recorded for anatomic form and surface roughness. The colour match of two restorations (2%) was recorded as an obvious mismatch, but otherwise no unacceptable scores were recorded. After two years of clinical service a high proportion (96%) of the Solitaire 2 restorations that were available for re-examination, placed in general dental practice settings, were found to be performing satisfactorily.