Cone beam computed tomography in dentistry: practitioner awareness and attitudes. A scoping review.

Familiarity with cone beam computed tomography is a requisite for all dental practitioners involved in its use or referral. This scoping review examines the knowledge, attitudes, competence and confidence of dental practitioners and students towards cone beam computed tomography in the dental setting. A search of Medline, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature was conducted to identify and chart existing evidence. Relevant studies written in English and published after 1998 and up to July 2020 were included. Of 679 papers, 39 studies were included for analysis. Key findings include deficient knowledge despite a widespread recognition of its importance and willingness to increase proficiency in its use, as well as a largely positive and optimistic view of the technology. Future studies on practitioners' knowledge and attitudes towards cone beam computed tomography are suggested to consider the contexts of an Australian setting.

Professionally Delivered Local Antimicrobials in the Treatment of Patients with Periodontitis-A Narrative Review.

This review sheds light on the recent published scientific evidence relating to the use of professionally delivered local antimicrobial agents (LA's). The review also analyses drug delivery systems available to date and provides an update on the latest scientific evidence about the benefits, limitations, and clinical results obtained by use of local drugs in the treatment of periodontal disease. The search strategy revealed randomized controlled trials (RCTs) that compared the efficacy of adjunctive LA's to mechanical therapy alone. Based on the available evidence gathered from this review, we can infer that the use of local antimicrobial agents in conjunction to scaling and root debridement (SRD) delivers significant benefits in periodontal therapy and it is a useful aid, avoiding many of the side effects that systemic antibiotic therapy may involve. Local drug delivery (LDD) is an efficient and effective means of delivering drugs based on the evidence presented in the review. The authors of this review would suggest the use of local antimicrobials in cases of localized periodontitis or individual areas that do not respond to the usual mechanical therapy alone. This review summarizes the current use of local drug delivery in periodontal management ensuring that the general practitioners are able to choose an appropriate local antimicrobial.

Management of Dental Avulsion Injuries: A Survey of Dental Support Staff in Cairns, Australia.

BACKGROUND/AIM: The aim of this study was to assess the knowledge of dental support staff in providing appropriate first-aid advice regarding dental avulsion emergencies. METHODS: This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Dental support staff (includes dental assistants, administrative staff and other non-clinical staff) were contacted and data were collected from 50 private dental clinics across the Greater Cairns Area, Queensland, Australia. These data were collected through an online survey throughout 2020. Descriptive statistics and Pearson's Chi-squared test was used to analyze the data and any associations between categorical outcomes. RESULTS: This survey yielded a response rate of 34.1% with a margin of error of 10.3%. More than four-tenths of participants (42%) reported that they had received some form of dental avulsion management training previously. All but five participants (92%) denoted that they would immediately replant an avulsed permanent tooth. More than half of all participants would choose to rinse a soiled avulsed tooth with fresh milk (55%) and transport that tooth in fresh milk (65%) should they not be able to replant the tooth at the site. Almost nine in every ten participants (85%) expressed willingness to further their training in this area. Knowledge in replanting avulsed permanent teeth was found to be significantly impacted by gender, age, years of experience and participation in formal avulsion training. Male participants were found to be significantly more likely (p = 0.025) to replant a permanent avulsed tooth than their female counterparts. Participants who were 40 years of age and above were found to be significantly more likely to choose fresh milk to transport avulsed teeth (p = 0.0478). Older participants (p = 0.0021), alongside those who had greater years of experience (p = 0.0112) and those who had undertaken formal avulsion training (p = 0.0106) were all significantly more likely to express greater confidence in their ability to manage dental avulsion injuries. Participants who had previously received some form of education regarding avulsion injury management were also most likely to warrant further education and training in this area (p < 0.0001). CONCLUSION: This study demonstrated that dental support staff in the Greater Cairns Area seem to have a fair grasp of first-aid knowledge regarding the management of dental avulsion injuries. This result indicates that this knowledge has been picked up through years of experience, rather than a formal education. Despite this, one would expect people who work in the dental industry to be able to provide accurate and appropriate assistance during dental emergencies, hence, further training is warranted to ensure optimum patient outcomes.

Comparison of Accuracy and Reliability of Working Length Determination Using Cone Beam Computed Tomography and Electronic Apex Locator: A Systematic Review.

AIM: To compare the accuracy and reliability of cone beam computed tomography (CBCT) and electronic apex locator (EAL) in determining the working length (WL). BACKGROUND: A comprehensive literature search was conducted across several databases and gray literature. A total of 1,358 potentially relevant journal articles were identified with publication dates ranging from 1996 to 2017. After screening and applying the inclusion and exclusion criteria, five studies were identified as eligible for review. Data extraction was completed in two blinded pairs, cross-referenced and subsequently merged. Discrepancies were resolved through collaborator mediation. Meta-analysis was not undertaken due to heterogeneity between included studies. REVIEW RESULTS: In all five studies, no statistically significant difference was found between CBCT and EAL measurements of WL. The reliability of CBCT compared with EAL was not determined. CONCLUSION: Due to significant heterogeneity between the included studies, the accuracy of CBCT compared to EAL couldn't be determined. Based on limited evidence, CBCT appeared to be as accurate as EAL. There was weak evidence suggesting that CBCT was reliable. Also the superiority of one method over the other could not be determined. These results should be interpreted judiciously. Further research is required to conclusively evaluate the accuracy and reliability of CBCT compared with EAL. CLINICAL SIGNIFICANCE: Preexisting CBCT scans may be appropriate for WL determination but acquiring a new CBCT for endodontic treatment is inadvisable due to cost and the as low as reasonably achievable (ALARA) principle.

Solitary Large Intraoral Neurilemmoma of the Maxillary Vestibule: A Rare Case with Brief Literature Review.

AIM: This current report aimed at presenting a rare case of a large solitary intraoral neurilemmoma of the buccal vestibule followed by a brief review of literature of neurilemmoma published between 1997 and 2017. BACKGROUND: The diagnosis of slow-growing intraoral lesions requires a thorough patient history and clinical examination. Despite the best efforts of even the most experienced oral medicine expert, a definitive diagnosis may sometimes only be reached through excisional biopsy and histopathological evaluation. CASE DESCRIPTION: To the best of our knowledge, there have been only two cases of neurilemmoma of the buccal vestibule reported in the literature till date and, looking at the size of the lesion, our case is the largest among the ones reported. CONCLUSION: In the present case, a rare presentation of solitary buccal vestibular neurilemmoma establishes the need for the consideration of a wide range of pathologies in the differential diagnosis. CLINICAL SIGNIFICANCE: Clinicians should include neurilemmoma in their differential diagnosis for asymptomatic, slow-growing intraoral growths and ensure complete excision to prevent tumor recurrence. The reader should be able to recognize the clinical features of neurilemmoma and describe the histopathological features and management of the condition.

Patients' views on dentists' ability to manage medical crises - results of focus group research.

BACKGROUND: Australia faces an ageing population which is more medically complicated than in years past, and it is important that we meet public expectations of management of medical emergencies in the dental clinic. No research before has examined in depth the public perception of dentists' medical emergency management. AIM: To qualitatively assess the publics' perception of medical emergencies in dentistry and their expectations of medical emergency management by dentists. METHODS: Twelve members of the public associated with a university clinic participated in two focus groups of six persons, where semi-structured discussions were carried out, audio recorded and transcribed, and subsequently underwent comprehensive thematic analysis. RESULTS: Key findings included a high expectation of dentists' general medical knowledge, as well as potential concern regarding a lack of routine medical assessment prior to undertaking dental treatment. CONCLUSIONS: Participants expected dentists to be highly proficient at managing medical crises and support the concept of medical emergency management certification for dentists.

Bilateral Bifid mandibular canals - Special relevance for a general dental practitioner. Report of 2 cases.

Dental practitioners may encounter bifid mandibular canals upon radiographic assessment, and may not understand the true extent of this presentation. The presentation of a bifid mandibular canal poses difficulties when carrying out dental procedures, including administration of mandibular block anaesthesia, oral surgical procedures of the lower third molars, orthognathic surgery and implant placement. Therefore it is of paramount importance that general dental practitioners be aware of the radiographic appearance, as incorrect diagnosis of this rare presentation can lead to detrimental consequences. The purpose of the communication is to draw dental practitioner's attention to the variations of bifid mandibular canals and ensure practitioners interpret radiograph correctly to make an informed diagnosis and eliminate the risk of damage and discomfort in the event of surgical treatment being carried out. It is advised that dental practitioners refer for further imaging such as a cone beam scan for greater understanding of the anatomical variation. Key words:Bifid mandibular canal, inferior alveolar nerve, bilateral bifid mandibular canal.

Comparison of cone-beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review.

The objective of the present systematic review was to analyze research articles that compare the accuracy of panoramic imaging to cone-beam computed tomography (CBCT) in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus. A comprehensive literature search was conducted using various databases. Initial searching yielded 64 results, and after exclusion, five full-text articles were eligible. All were cohort studies, and the CBCT and panoramic images were either obtained from a pre-existing database or patients were recruited specifically for the study. Analysis showed that a panoramic image is sufficient for accurately detecting when the roots are at distinct distance from the sinus. However, if the roots are either laterally or medially projecting over the sinus and "just touching" it, panoramic images generally misinterpret this position, and instead make the root appear to be in the sinus. There were mixed results for when the root tip penetrates the sinus. Some studies claimed there was high agreeance between both modalities in this situation, while others had a low level of agreeance. In these situations, ordering a CBCT should be strongly considered to properly assess oral surgery risk with regard to maxillary posterior teeth.

Investigation of radiation-protection knowledge, attitudes, and practices of North Queensland dentists.

AIM: Queensland has current radiation-protection guidelines; however, with the absence of data exploring compliance and implementation, the efficacy is unknown. The aim of the present study was to investigate the knowledge and attitudes on radiation protection among private North Queensland (NQ) dentists. METHODS: A quantitative methodology was employed in an observational and descriptive study using questionnaires for data collection. RESULTS: Of the 154 questionnaires distributed, 63 were completed and returned. The respondents' knowledge concerning the technical details of their equipment was limited, with 31.5% and 47% not knowing the tube voltage and current utilized for their machines, respectively. In total, 23.8% of dentists had limited knowledge about the speed of the conventional film they used, 90.5% of respondents agreed that the role of imaging in dentistry is important, and 75.8% dentists reported the thyroid as the most important organ to protect during dental radiography. Their knowledge regarding position-distance rule was reasonably adequate; 80.3% of the dental practices appeared to follow the Australian Radiation Protection and Nuclear Safety Agency guidelines, 95.2% preferred taking radiographs if it was only urgent, and 69.8% identified a need for spreading awareness regarding radiation protection. CONCLUSIONS: An opportunity and need for further continuing education was identified among NQ dentists to ensure safety of patients.

Age and gender correlation of gonial angle, ramus height and bigonial width in dentate subjects in a dental school in Far North Queensland.

BACKGROUND: This study aimed to determine if mandibular parameters (gonial angle, bigonial width and ramus height) measured from panoramic radiographs, can be used to determine a correlation with an individual's age and gender in dentate subjects in Far North Queensland. MATERIAL AND METHODS: The study utilised 2699 randomly selected panoramic radiographs of patients between the ages of 19-69 years, from which 220 fulfilled the inclusion criteria. Each panoramic radiograph was analysed and the above three parameters recorded and measured. These values were collated into appropriate age and gender groups and subjected to statistical analysis. RESULTS: The mean age of the participants was 44.1±14.41, with males being shown to have a statistically significant larger ramus height and bigonial width than females (P<0.0001 for both). Females, on the other hand, were shown to have a significantly larger gonial angle than males (P<0.0002). General trends revealed gonial angle to increase with age, whilst bigonial width and ramus height were shown to decrease with age. CONCLUSIONS: The assessment of mandibular morphology through radiographic measurements may be useful in estimating an individual's age and gender when comparing to a known population standard. KEY WORDS: Bigonial width, gonial angle, panoramic radiograph, ramus height.

Panoramic radiographic study of mental foramen in selected dravidians of south Indian population: A hospital based study.

BACKGROUND: This study aimed at documenting information on appearance, size, horizontal and vertical locations of Mental Foramen (MF) in Panoramic Radiograph. We also analyzed the age and gender differences with radiographic appearance and location of MF. We evaluated these findings in our population and co-relate with results of previous studies. MATERIAL AND METHODS: 1662 panoramic radiographs were evaluated, of which 245 fulfilled the inclusion criteria. Each radiograph was traced to record the horizontal and vertical locations. The size of MF was recorded using digital caliper and its appearance was determined by visual examination. Chi-square and t-test were employed. RESULTS: The most common appearance of MF was continuous type and the tests showed significant difference with age and gender. The most frequent horizontal location of MF was "location c" with no statistical significant difference with age and gender. The MF was most commonly positioned mesially in relation to the apex of second premolar with no significant differences with gender. The vertical location of the foramen varied drastically with no statistical significant difference in both sides. The difference in dimensions on the left and right sides were not statistically significant. CONCLUSIONS: Determining the morphological appearance and positional variation of MF is important for isolation of mental nerves and vessels when administering local anesthesia and performing surgeries. We therefore stress the importance of accurate radiographic identification of MF and interpretation. Our research findings can be used as reference material by the dental practitioners of South India while performing clinical procedures that involve MF. KEY WORDS: Mental foramen, mental nerve, panoramic radiograph, mandible.

Recurrent exophytic growth on maxillary posterior edentulous alveolar ridge--a diagnostic challenge.

Accurate diagnosis of recurrent intra-oral exophytic lesions require a thorough history, meticulous clinical examination and the experience of assessing these lesions, because they are not commonplace. Despite this, instituting the correct diagnosis tests the skills of an oral medicine expert. Therefore, the same is all the more challenging for a general practitioner who may encounter these lesions without any significant experience. The importance of diagnosing such lesions cannot be understated, as they may represent a myriad of conditions ranging from seemingly innocuous benign pathologic processes to much more sinister ones, like oral malignancy; occasionally some of these lesions may manifest atypically. Such atypical presentations may cloud the diagnostic process. Here a case uncharacteristic of the condition it represented is reported with the aim of increasing awareness of the diagnosis of such lesions.

Condylar Changes and Its Association with Age, TMD, and Dentition Status: A Cross-Sectional Study.

The present study was undertaken to evaluate the prevalence of radiographic changes in the condylar morphology and its association with age, clinical signs and symptoms of temporomandibular dysfunction and dentition status and also to evaluate the intra examiner and inter examiner reliability in assessing condylar changes using panoramic radiographs. A total of 75 subjects were recruited for the study. They were divided into 3 age groups. 20-40 yrs (Group A), 41-60 yrs (Group B) and 61 yrs and above (Group C). In each age group 25 subjects were evaluated both clinically and radiographically. The prevalence of radiographic changes in condylar morphology and symptoms of temporomandibular dysfunction was 81.3% and 18.6%, respectively. Radiographic abnormalities in the mandibular condylar morphology increased with age. They were seen more frequently in patients with clinical signs and symptoms of temporomandibular dysfunction and in patients with loss of teeth. Intra examiner and inter examiner reliability was high indicating a good reliability in assessing the condylar changes using panoramic radiograph.

Comparison of efficacy of sodium hypochlorite with sodium perborate in removal of stains from heat-cured clear acrylic resin.

Acrylic resin bases of removable dentures attract stains and odor-producing organic and inorganic deposits. The use of chemical denture cleanser soaks is the most popular method of denture cleansing. This study was undertaken to compare the efficacy of two different denture cleansers--sodium perborate (Clinsodent) and sodium hypochlorite (VI-Clean)--in removing tea, coffee, turmeric and tobacco (paan) stains from heat-cured clear acrylic resins. Distilled water was used as a control. Both Clinsodent and VI-Clean were found to be the least effective in removing coffee stains and best for removing turmeric stain. It is necessary that the dental professional be aware of these results to ensure that denture wearers know how to select the appropriate denture cleanser.

Kocher Debre Semelaigne syndrome and associated orofacial aspects: report of a case.

Myopathy and muscular pseudohypertrophy associated with severe congenital hypothyroidism has been described as Kocher Debre Semelaigne syndrome, which is a rare disorder with only a few previously published reports. However, none of these reports have described the orofacial aspects of this syndrome. Here we report one such case, which may provide valuable information to specialists in oral healthcare regarding the associated orofacial aspects.

Total anodontia in patient with hypohidrotic ectodermal dysplasia. Report of rare case of Christ-Siemens Touraine syndrome.

Ectodermal dysplasias are a complex group of genetically determined disorders clinically characterized by congenital alterations of the structures derived from the ectoderm. Even though ectodermal dysplasia with partial anodontia is common, this condition with total anodontia is not. We describe features of hypohidrotic ectodermal dysplasia with complete anodontia in a 6-year-old boy. In order to improve esthetics, speech and mastication, the child was provided with upper and lower complete dentures.

Dental considerations in pregnancy: review / Considerações odontológicas na gravidez: revisão

OBJETIVO: Este artigo propõem-se a revisar as alterações ocorridas na mulher durante a gravidez. Os cirurgiõesdentistas devem conhecer os procedimentos seguros e os que devem ser evitados durante as várias fases da gravidez. DISCUSSÃO E CONCLUSÃO: Este artigo aborda as várias alterações sistêmicas vistas na mulher grávida e como essas alterações devem ser manejadas na execução de procedimentos odontológicos. Os cirurgiões-dentistas devem ter sólido conhecimento a respeito dos efeitos da radiação sobre o feto e também dos efeitos de várias drogas usadas durante o tratamento odontológico. Com comunicação adequada e bom conhecimento, várias complicações podem ser evitadas durante a gravidez, culminando em benefícios para a mãe e o bebê.

OBJECTIVE: This article is aimed to review the changes occurring in a woman during pregnancy. Dentists should know what procedures are safe and those to be avoided during various phases of pregnancy. DISCUSSION AND CONCLUSION: This article reflects the various systemic and local changes seen in a pregnant woman and how these changes should be considered while carrying out dental procedures. Dentists should have a sound knowledge about effects of radiation on the fetus and also effects of various drugs used during dental treatment. With proper communication and good knowledge, various complications can be avoided during pregnancy and would be beneficial to both the mother and the fetus.