Orthodontic apps: an assessment of quality (using the Mobile App Rating Scale (MARS)) and behaviour change techniques (BCTs).

BACKGROUND: Apps have been shown to be an effective tool in changing patients' behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published. OBJECTIVES: 1. To evaluate the quality of these apps aiming to change behaviour. 2. To assess BCTs used in patient focused orthodontic apps. METHODS: The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors. RESULTS: BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly 'prompts/cues', and 'information about health consequences'. All apps were shown to be of moderate quality (range 3.1-3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent. CONCLUSIONS: The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients' compliance with treatment.

The orthodontic-oral surgery interface. Part two: diagnosis and management of anomalies in eruption and transpositions.

The orthodontic-oral surgery interface is important for the multidisciplinary management of patients presenting with complex dental anomalies. This article provides an overview of anomalies of eruption and transpositions, their diagnosis, aetiology, presenting features and the different management options. It also highlights the role of the general dental practitioner (GDP) in identifying such anomalies and the importance of timely referral to specialist care.

Interventions for the prevention of dry socket: an evidence-based update.

This paper reviews the latest evidence for local and systemic interventions for the prevention of alveolar osteitis (dry socket). Dry socket is a painful and common post-operative complication following exodontia. Any interventions for the prevention of dry socket could reduce both its incidence and help avoid this painful complication. Prophylactic measures proposed in the literature are discussed. Furthermore, this article discusses both the clinical and histological stages of a normal healing socket.

Susuk charms? A case report.

This case report describes an interesting incidental finding on an orthopantomogram: bilateral radio-opaque objects in the mandibular rami region. The origin of the objects remains unidentified; however, the authors have tentatively identified these as being susuk by a process of exclusion of other possibilities.

A practice-based randomised controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity.

OBJECTIVES: The aim of this study was to evaluate the efficacy of three different interventions (non-desensitising toothpaste, desensitising toothpaste and professionally applied dentine bonding agent) in reducing dentinal hypersensitivity over a 2-week, 3-month and 6-month-period in a dental practice setting. METHODS: This was a randomised controlled, single-blind; parallel-group trial conducted in general dental practice by a single general dental practitioner. Seventy-five subjects were randomly allocated to three groups; non-desensitising toothpaste (NDT), desensitising toothpaste (DT) and professionally applied desensitising agent (DA). Dentinal hypersensitivity was measured using a Visual Analogue Scale (VAS) to record the response from a standardised short blast of air from a triple syringe. Dentinal hypersensitivity was recorded at baseline, two weeks, three months and six months for all groups. RESULTS: Dentinal hypersensitivity reduced significantly (p<0.0001) in both groups DT and DA, in addition the reduction in sensitivity was sustained and continued to improve over a 6-month-period. The greatest reduction in dentinal hypersensitivity was recorded in group DA. CONCLUSIONS: The results from this study suggest that application of dentine bonding agents, to teeth diagnosed with dentine hypersensitivity provides the greatest improvement in dentine hypersensitivity at 2 weeks and 6 months. This reduction in dentine hypersensitivity is greater than that achieved by the desensitising toothpaste tested and a non-desensitising toothpaste.

Contemporary orthodontics: the micro-screw.

Micro-screws (MSs) have gained rapid popularity among orthodontic specialists over the past decade. Subsequently, as general dental practitioners (GDPs) continue to provide general care for patients undergoing orthodontic treatment they are likely to encounter MSs. This article is aimed at GDPs and provides an overview of MS design, placement, removal and safety. Two examples of treated cases will also be used to demonstrate the use of MSs in contemporary orthodontic practice.

Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice.

OBJECTIVE: The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE. DESIGN: Cross sectional study of a sample of 164 adult patients. SETTING: General dental practice in East Lancashire, UK in 2010. SUBJECTS: Patients attending for routine examination or treatment. MAIN OUTCOME MEASURES: By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established.Results The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κ(w) = 0.43 and 0.57 respectively). CONCLUSION(S): BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Adaptive toothbrush handle: case report of a Thalidomide patient.

Thalidomide poisoning can result in malformation of limbs, specifically upper limbs, compromising manual dexterity. Although Thalidomide has long since been withdrawn for use in pregnant patients, its affects on those exposed pose significant challenges for patients' oral hygiene maintenance. This case reports a novel technique of adaptation to facilitate a Thalidomide poisoned patient in maintenance of oral hygiene via an adaptive toothbrush handle.

Estimating the need for dental sedation. 4. Using IOSN as a referral tool.

OBJECTIVE: In this article we report on the use of the IOSN as a referral tool in primary care and the need for sedation in the referred patient population (as determined by the IOSN score). SETTING: Four centres in the North West of England (primary care) accepting referrals for treatment with the aid of sedation participated in this study. DESIGN: A service evaluation. SUBJECTS (MATERIALS) AND METHODS: The four were provided with IOSN referral forms, operator and patient questionnaires. The centres distributed IOSN forms to referrers as a means of recommending patients for sedation. All patients receiving treatment under sedation (having been referred for treatment through the IOSN form) were asked to complete the patient questionnaire. The individual operator who undertook the treatment under sedation was asked to complete the operator questionnaire. Data were entered into SPSS and the IOSN score noted. Statistical analyses of the data utilised descriptives and comparisons between groups using the Chi Squared test. RESULTS: Seventy-eight percent of the patients (n = 140) in this study were receiving treatment with sedation appropriately according to the principals of the IOSN. Patients deemed by the IOSN tool to have a low need for sedation were less likely to cancel their appointment if sedation had not been given. The majority of patients were female (70%) and the majority of operators and patients reported the IOSN forms acceptable for use. CONCLUSIONS: This study provides support for using the IOSN as a tool for organising sedation referral. The majority of operators and patients reported the IOSN forms acceptable for use.

Contemporary dental practice in the UK in 2008: indirect restorations and fixed prosthodontics.

OBJECTIVES: To investigate, by postal questionnaire, various aspects of primary dental care provision in the United Kingdom. Additionally, to compare the results of this survey with a similar survey completed four years previously. METHODS: A questionnaire containing 89 questions was sent to 1,000 general dental practitioners selected at random from databases of practitioners throughout the United Kingdom. Non-responders were sent another questionnaire after a period of four weeks had elapsed. RESULTS: Overall a response rate of 66.2% was achieved. Amalgam was the preferred material for the core build up of vital teeth for 65% of the respondents. Dentine pins were still being used by practitioners, with stainless steel pins being preferred by 34% of respondents. 39.7% of dentists that had graduated between 0-10 years previously reported using no pins. Indirect posts were still used most widely, by 55% of the practitioners in the study, with increasing use of fibre posts noted (34%). Addition cured silicone impression materials were still the most frequently used impression material (71%) with reduced use (10%) of condensation cured silicone impression materials recorded. Glass ionomer luting cements (48%) and zinc phosphate (28%) were the most commonly used luting cements. CONCLUSIONS: Within the limitations of this study, the following conclusions can be drawn: amalgam is still the preferred material for the core build-up of vital teeth; dentine pins are still used widely, but not by younger practitioners; fibre posts are being increasingly used by practitioners; addition cured silicone is still the most widely used impression material; traditional glass ionomer cements are still the most widely used luting cements; veneers are still the preferred indirect restoration for restoring anterior teeth; and CAD/CAM systems are increasingly being used by practitioners.

Contemporary dental practice in the UK: demographic details and practising arrangements in 2008.

OBJECTIVES: To determine, by postal questionnaire, the demographic profile and practising details of general dental practitioners in the UK in 2008. METHODS: A piloted 89 question postal questionnaire was distributed in 2007/2008 to 1,000 dentists, with effective addresses in the UK, whose names and addresses were obtained by random selection from the General Dental Council (GDC) register. RESULTS: Six hundred and ninety-one questionnaires were returned, of which 662 were useable - an acceptable 66% useable response rate. Of the respondents, 69% were male and 59% were practice principals. Fifty-three percent of the respondents' practices were in town or city centres with a wide geographic distribution. Single-handed practitioners accounted for 17% of respondents, with the mean number of dentists per practice being 3.6 (median 3.0). Typically, respondents' practices provided a mean of 26 patient care sessions per week, with each dentist treating on average 15 patients per session - 16 minutes per patient on average including surgery turnaround time, assuming 4 hour sessions. Hygienists typically treated seven patients per session - 34 minutes per patient on average including surgery turnaround time, assuming 4 hour sessions. Respondents stated that 57% of patients were treated under the NHS arrangements, with 28% being private, 7% independent and 7% insurance-based. Responses indicated that 73% of the respondents used a computerised patient management system, 67% had an internet connection and 60% used email, principally for correspondence, ordering materials and other uses such as referrals and research. Forty-five percent of respondents owned an intra-oral camera, with 45% of those using it routinely. Regarding new concepts, the use of nickel-titanium endodontic files (61%), digital imaging (28%) and zirconia all-ceramic bridgework (27%) were the most frequently cited innovations currently used by the respondents. Regarding the most notable changes in findings when compared with a related study conducted in 2000, these were connected to the method of payment with the proportion of NHS patients dropping to 57% compared with 86%; the volume of postgraduate education undertaken by dentists, with a 50% increase in the proportion of respondents having attended five or more courses each year (63% compared with 40% in 2000); and the use of zirconia all-ceramic bridgework (27% of respondents). CONCLUSIONS: The findings of the present study are considered to indicate increasing commercialism of dentistry in the UK, with evidence of many practitioners adopting new technologies, underpinned by substantial participation in postgraduate education.

Contemporary dental practice in the UK in 2008: aspects of direct restorations, endodontics and bleaching.

OBJECTIVE: To investigate, by postal questionnaire, aspects of the selection and use of direct restorative materials, endodontic techniques and approaches to bleaching by general dental practitioners in the UK, and to compare and contrast the findings with those of a related study reported in 2004. METHODS: A questionnaire comprising 18 questions, each of a number of elements, was sent to 1,000 general dental practitioners in the UK, selected at random from the Dentists Register. Non-responders were sent a second copy of the questionnaire after a period of four weeks had elapsed. RESULTS: A total of 662 useable responses were returned, giving a response rate of 66%. Key findings included: dental amalgam was found to be the most commonly used material in the restoration of occlusoproximal cavities in premolar (59% of respondents) and molar teeth (75% of respondents); glass-ionomer cements and related materials were applied extensively in the restoration of deciduous molars (81% of respondents) and for the luting of indirect restorations (67% of respondents); the use of rubber dam was limited, in particular as an adjunct to procedures in operative dentistry (18% of respondents); relatively few respondents used preformed stainless steel crowns, and among the users only occasionally in the restoration of deciduous molars (23%); and bleaching, predominantly home-based (nightguard) vital bleaching (81% of respondents) was widely practised. CONCLUSION: It is concluded that, for the practitioners surveyed, factors other than best available evidence influenced various aspects of the use of direct restorative materials and the clinical practice of endodontics. As a consequence, many of the features of general dental practice revealed in the process of the investigation were at variance with teaching in dental schools. Bleaching, in particular home-based (nightguard), vital bleaching, was provided by >80% of respondents, indicating widespread interest among patients in enhanced dental attractiveness.

Estimating the need for dental sedation. 2. Using IOSN as a health needs assessment tool.

AIM: This service evaluation assessed the need for sedation in a population of dental attenders (n = 607) in the North West of England. METHODS: Using the novel IOSN tool, three clinical domains of sedation need were assessed: treatment complexity, medical and behavioural indicators and patient reported anxiety using the Modified Dental Anxiety Scale. RESULTS: The findings suggest that 5% of the population are likely to require a course of treatment under sedation at some time. All three clinical domains contributed to the IOSN score and indication of treatment need. Females were 3.8 times more likely than males to be placed within the high need for sedation group. Factors such as age, deprivation and practice location were not associated with the need for sedation. CONCLUSIONS: Primary care trusts (PCTs) need health needs assessment data in order to commission effectively and in line with World Class Commissioning guidelines. This study provides both an indicative figure of need as well as a tool by which individual PCTs can undertake local health needs assessment work. Caution should be taken with the figure as a total need within a population as the study has only included those patients that attended dental practices.

A clinical study comparing the efficacy and sensitivity of home vs combined whitening.

This randomized clinical study assessed efficacy in terms of color change and production of sensitivity after home whitening alone and home whitening supplemented with in-office bleaching. Thirty-six subjects (aged 19 to 58 years) were randomly assigned to one of three different treatment groups: (A) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays; (B) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 9% hydrogen peroxide (in the same trays); or (C) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 27% hydrogen peroxide (in the same trays). The efficacy of tooth whitening was assessed by determining the color change associated with the six upper anterior teeth using a value-ordered shade guide. Sensitivity was self-assessed with the use of a visual analog scale (VAS). Tooth shade and sensitivity were assessed at the following points: pretreatment; immediately after the home whitening phase; immediately after the in-office phase (groups B and C); and one week post active treatment. At the one week follow-up visit, subjects in group A had a mean (SD) color change of 5.9 (1.83) (teeth were lighter) immediately after cessation of treatment (p<0.01). Subjects in groups B and C experienced a greater change in mean (SD) shade immediately following their respective in-office treatments of 5.1 (1.53) and 5.4 (1.55). However, within one week, the shade of these teeth regressed to a similar degree to that achieved by subjects treated in group A. Overall, no significant difference in shade change or sensitivity was produced between the three groups. Investigators concluded that the in-office element of combined whitening produced no significant difference in tooth color or sensitivity when compared with home whitening alone.

Repair or replacement of restorations: do we accept built in obsolescence or do we improve the evidence?

INTRODUCTION: Controversy surrounds decisions on whether to repair or replace defective dental restorations. The concept of built-in obsolescence, ie periodic replacement of dental restorations, is largely accepted as the modus operandi if not the default mode in restorative care. In this article we examine the current best available evidence underpinning the effectiveness of replacement versus repair of direct amalgam and resin composite restorations. METHOD: This article builds on two recent Cochrane systematic reviews which have reported on the evidence base supporting the effectiveness of replacement versus repair of amalgam and direct resin composites and translates the results of their research conclusions into recommendations for the dental clinician. RESULTS: As no relevant randomised controlled trials (RCTs) were identified in either of these systematic reviews, the evidence regarding the effectiveness of repair versus replacement of amalgam and composite restorations is weak and incomplete. The evidence as it currently stands seems to favour repair over replacement, but this is insufficient to make firm recommendations. CONCLUSION: In view of the absence of high level evidence there is a need for further well designed RCTs. To add value to the evidence base these trials should be conducted in a general practice setting which will strengthen the generalisability and applicability of the research conclusions and enable dentists and patients to make informed decisions.