Current practices and attitudes of dental practitioners regarding the provision of dental treatment for patients with solid organ transplants.

BACKGROUND: Solid organ transplant provides a lifeline for people with end stage organ failure. Each year the number of individuals in receipt of a solid organ transplant is increasing. Prevention of post-transplant sepsis and infection are critical for transplant success. The oral cavity contains more than 700 different species of bacteria and is a potential reservoir for disease causing pathogens. Prior to undergoing solid organ transplant, individuals must receive a certification of dental health from a dental practitioner. There are currently no guidelines or protocols for dental practitioners to follow when certifying a patient as dentally fit. This allows for a wide variation of the term 'dentally fit'. This survey was conducted as part of a larger study assessing the oral health of adults with cystic fibrosis ongoing in Cork University Dental School and Hospital. The aim of the study was to ascertain current practices and attitudes of dental practitioners regarding the provision of dental treatment pre and post solid organ transplantation. METHODS: An anonymous cross sectional survey of dental practitioners in Ireland was conducted. RESULTS: The data collected showed a wide variation in the provision of treatment for patient undergoing or in receipt of a solid organ transplant. CONCLUSION: It demonstrates a need for further research to be conducted to ascertain the full impact solid organ transplant has on oral health, so that guidelines can be developed to aid both dental and medical professionals in the treatment of this vulnerable cohort.

Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

OBJECTIVE: To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. BACKGROUND: Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. MATERIALS AND METHODS: This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. RESULTS: A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. CONCLUSION: Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

Failure rates of class V restorations in the management of root caries in adults - a systematic review.

OBJECTIVE: The aim of this systematic review was to compare cumulative failure rates of different restorative materials in carious class V lesions on the root surfaces of adult patients. BACKGROUND: The prevalence of root caries is set to increase in the coming years as a result of ageing of the population and a concomitant reduction in levels of edentulousness. Evidence is needed to assist practitioners to select the most appropriate restorative material for use in these lesions. METHODS: A search of the literature was undertaken using the electronic databases of PubMed, Embase, CENTRAL and OpenSIGLE using keywords relevant to the search question. Two review authors conducted the electronic search independently, and any conflict was resolved by discussion. The references quoted in the full text articles extracted were hand searched for any further eligible studies. RESULTS: Sixty non-duplicate citations were screened. Following review of the titles, abstracts, texts and application of the pre-determined inclusion/exclusion criteria, five studies remained. CONCLUSION: There is a need for more research in this area as many of the studies identified in this systematic review treated post-radiation, xerostomic patients which are not typical of the general population. Increased adherence to CONSORT guidelines for reporting is also advised to facilitate future systematic review and meta-analysis in this area.

The prevalence of developmental defects of enamel in a cohort of adults with cystic fibrosis - A cross sectional study.

OBJECTIVES: Cystic Fibrosis is an autosomal recessive condition. It is a multisystem disease treated with a broad range of pharmacological therapies, diet and nutrition, and physiotherapy. Previous studies suggest that people with cystic fibrosis have a higher prevalence of developmental defects of enamel which may place this population at a greater risk of developing oral diseases such as caries. The aim of this study was to assess a cohort of people with cystic fibrosis (PwCF) for the presence of developmental defects of enamel and compare the results with a control group of people without cystic fibrosis. METHODS: A cross sectional study involving 92 participants with cystic fibrosis and 92 controls was conducted in Cork University Dental School & Hospital. All participants completed a detailed questionnaire prior to undergoing a full clinical examination. The Developmental Defect of Enamel Index was used as a measurement index. All data was statistically analysed with the help of statisticians from Cystic Fibrosis Registry of Ireland. RESULTS: 64 % (n = 59) of PwCF had enamel defects compared to just 30 % (n = 28) of people without cystic fibrosis. The median number of teeth affected by enamel defects in the study group was 1.5, compared to 0 in the control group. CONCLUSION: In this study the cohort of PwCF had more enamel defects than people without CF. Further research is required to investigate the aetiology of these findings. CLINICAL SIGNIFICANCE: Clinicians should be vigilant after teeth have erupted in PwCF as they may have an increased susceptibility to developmental defects of enamel.

Toothwear and the older patient.

UNLABELLED: Toothwear is commonly observed in dentate older patients and may be physiological or pathological in nature. Toothwear can be caused by abrasion, attrition, erosion or a combination of aetiologies. Where treatment is required, a number of options exist, including the use of adhesive materials and fixed and removable prosthodontics. CLINICAL RELEVANCE: With patients retaining natural teeth into old age, physiological and pathological toothwear amongst dentate older patients is an increasingly common presentation.

Caries and the older patient.

UNLABELLED: Ageing of the population, together with prolonged retention of teeth, has brought new challenges to dentistry. Whereas in the past oral care for the elderly was restricted to provision of dentures, older patients are now presenting with dental caries and failed restorations. These problems may have an impact on their general health and quality of life. Poor oral hygiene, xerostomia and diet are among the risk factors for caries in older patients and need to be addressed in order to achieve control of the disease. Carious lesions can be treated conservatively in many cases or may need surgical management. CLINICAL RELEVANCE: Caries is an oral health issue among older patients and can result in tooth loss. Oral health has a great impact on general health and quality of life of elderly people.

Gerodontology in Context.

The impact of ageing on society, the patient and his/her oral state is summarized, with one case being outlined as an example.

Age-related oral changes.

UNLABELLED: Age-related oral changes are seen in the oral hard and soft tissues as well as in bone, the temporomandibular joints and the oral mucosa. As older patients retain their natural teeth for longer, the clinical picture consists of normal physiological age changes in combination with pathological and iatrogenic effects. CLINICAL RELEVANCE: With an ageing population retaining more of its natural teeth for longer, dental professionals should expect to observe oral age changes more frequently.

Gerodontology: Now and the Future.

In this the first article in a series, the discipline of Gerodontology is placed in context and the issues of what constitutes ageing, the demography of the older population, and changes in oral health are considered. Future clinical challenges to the profession and in the delivery of oral healthcare are also outlined.

Bonding auto-polymerising acrylic resin to acrylic denture teeth.

This study investigated the effect of surface treatments on the shear bond strength of an auto-polymerising acrylic resin cured to acrylic denture teeth. The surface treatments included a combination of grit-blasting and/or wetting the surface with monomer. Samples were prepared and then stored in water prior to shear testing. The results indicated that the application of monomer to the surface prior to bonding did not influence the bond strength. Grit blasting was found to significantly increase the bond strength.

Prospective evaluation of the referral pattern to restorative dentistry consultation clinics in Ireland.

The objective of this study was to analyse pattern of referral to Restorative Dentistry Consultation Clinics in a Dental Teaching Hospital. Patient demographic details and referral information were collected on new patient clinics. The majority of patients were female (62.1%). The greatest proportion of patients, 41.6%, was referred from the adjacent urban area. The highest percentage of referrals was from general practitioners, (37.6%). The main referral reasons were periodontal (24.7%), fixed prosthodontics (18.6%), endodontics (10.7%) and removable prosthodontics (8.3%). The study clearly showed that the majority of patients referred were female and from close proximity to the Hospital. Patients were referred for a broad range of restorative reasons.

Surface microhardness of a resin composite: a comparison of a tungsten halogen and a LED light curing unit, in vitro.

A comparison has been made between published surface microhardness numbers (VHN) of a commercial resin composite for different exposure times to a quartz tungsten halogen (QTH) and light-emitting diode (LED) light-curing unit (LCU). Both LCUs produced comparable hardness at both top and bottom surfaces, respectively, and similar bottom/top hardness ratios, for a specimen thickness of 1.5 mm, given sufficient exposure time (40 s) and an elapsed time of 24 h before measurement (for hardness numbers). However, some data are significantly different. There is no advantage in either LCU regarding optimal hardness and hardness ratios given an appropriate protocol. Immediate finishing (1 h) was more appropriate to the use of the LED LCU (with adequate exposure time). The effect of elapsed time after exposure on microhardness was more pronounced with the QTH LCU.

The effect of endodontic access on all-ceramic crowns: A systematic review of in vitro studies.

OBJECTIVES: The aim of this systematic review was to identify from in vitro studies the effect of endodontic access on the fracture resistance and damage around the access cavity of all-ceramic crowns. DATA: The articles identified were screened by two reviewers according to inclusion and exclusion criteria. The reference lists of articles advanced to second round screening were hand searched to identify additional potential articles. The risk of bias for the articles was independently performed by two reviewers. SOURCES: An electronic search was conducted on PubMed/Medline, Web of Science, Scopus and Embase databases with no limitations. STUDY SELECTION: 383 articles were identified, of which, eight met the inclusion criteria and formed the basis of this systematic review. Factors investigated in the selected articles included the, presence of microcracks at the access cavity, repair protocol, ceramic type, crown fabrication method, luting agent and grit size of the diamond bur. The risk of bias was deemed to be high for three, medium for two and low for three of the reviewed studies. The high level of heterogeneity across the studies precluded meta-analyses. CONCLUSION: Based on the currently available scientific evidence, a 'best practice' protocol with regard to improving the fracture resistance of endodontically accessed and repaired all-ceramic crowns cannot be conclusively identified. However, some key factors which potentially impact on the fracture resistance of endodontically accessed and repaired all-ceramic crowns have been isolated. Cautious clinical interpretation of these factors is concluded for the maintenance of the crown as a permanent restoration. CLINICAL SIGNIFICANCE: Key factors which impact on the fracture resistance of endodontically accessed and repaired all-ceramic crowns have been isolated from in vitro studies. Cautious clinical interpretation of these factors is advised for the maintenance of the crown as a permanent restoration.

Early surface microhardness of a resin composite exposed to a pulse-delayed curing exposure: a comparison of a tungsten halogen and a plasma arc lamp, in vitro.

Surface microhardness numbers of a commercial resin composite have been compared after exposure to a quartz tungsten halogen (QTH) and plasma arc (PAC) lamp respectively, using two exposure protocols. The effect of increased tip-to-composite distance has also been compared. Exposure with the PAC lamp tested is more appropriate to the early finishing of composite restorations after placement and curing than with the QTH. However both lamps were capable of producing comparable surface hardness, with appropriate exposure protocols. The effect of increased tip-to-composite distance was generally not significant between the lamps for continuous exposure.

In vitro study of surface microhardness of a resin composite exposed to a quartz-halogen lamp.

OBJECTIVES: To determine the minimum exposure times consistent with optimized surface microhardness numbers (VHN) for the top and bottom surfaces, respectively, of a resin composite (1.5-mm depth) cured using a quartz-halogen activation lamp. Additionally, to determine the conditions appropriate to achieve optimized bottom/top hardness ratios. METHOD AND MATERIALS: Disk specimens of a commercial resin composite restorative (Spectrum TPH) were exposed to a quartz-halogen lamp, and VHNs were measured for the top and bottom surfaces at elapsed times of 1 hour and 24 hours. RESULTS: Data were dependent on exposure time, time elapsed after exposure, and the surface involved. Exposure time featured limiting values in excess of which no significant increase in microhardness took place. All microhardness data increased significantly over an elapsed time interval between 1 hour and 24 hours postexposure. Microhardness ratios (bottom/top) were dependent on exposure time only and were not influenced by time elapsed after exposure. CONCLUSION: Minimum exposure time may be considered as the greater of the times to achieve optimized top hardness and optimized hardness ratio, respectively.

The influence of coronal restoration type on the survival of endodontically treated teeth.

The aim of this study is to investigate the association between coronal restoration type and survival of endodontically treated teeth. A review was performed of treatment records of patients who had endodontic treatment performed in the Department of Restorative Dentistry, University Dental School & Hospital, Cork, Ireland during the period 1993-96. Demographic and dental factors such as age, gender, tooth type, coronal restoration type, and tooth status recorded at a review appointment were recorded. Tooth status at review was defined as 'tooth present' or 'tooth absent' based on the presence or absence of the endodontically treated tooth recorded in the treatment records at a review appointment held a minimum of one year following obturation of the root canal system. Of 176 teeth (166 patients) treated, survival of endodontically treated teeth was significantly more likely where restored with cast restorations (91.7%), amalgam restorations (86.5%), or composite restorations (83.0%), than teeth restored with temporary restorations (34.5%) (p<0.0001) (mean follow-up time 38 months, range 12-60 months). Survival of endodontically treated teeth was found to be associated with permanent coronal restorations. Loss of endodontically treated teeth occurred more often with those restored with temporary restorations (34.5%) than other restoration types (p<0.05).

Surface microhardness of a resin composite exposed to a "first-generation" LED curing lamp, in vitro.

This investigation determined the minimum exposure times consistent with optimised surface microhardness parameters for a commercial resin composite cured using a "first-generation" light-emitting diode activation lamp. Disk specimens were exposed and surface microhardness numbers measured at the top and bottom surfaces for elapsed times of 1 hour and 24 hours. Bottom/top microhardness number ratios were also calculated. Most microhardness data increased significantly over the elapsed time interval but microhardness ratios (bottom/top) were dependent on exposure time only. A minimum exposure of 40 secs is appropriate to optimise microhardness parameters for the combination of resin composite and lamp investigated.

Surface microhardness of a resin composite exposed to pulse-delayed plasma arc lamp irradiation, in vitro.

Groups of samples of a light-activated resin composite were exposed, using a 3-step pulse-delayed protocol, to a plasma arc unit. Further groups were exposed with the light-curing guide positioned at increasing distances from the composite surface. The pulse-delayed protocol yielded a progressive increase in microhardness number at the end of each step but with a maximum mean value significantly less than the controls. Increasing the irradiation distance yielded a progressive and significant decrease in microhardness number.

Endodontic access cavity simulation in ceramic dental crowns.

OBJECTIVES: It is proposed that a non-uniform rational B-spline (NURBS) based solid geometric model of a ceramic crown would be a flexible and quick approach to virtually simulate root canal access cavities. The computation of strain components orthogonal to surface flaws generated during the drilling would be an appropriate way of comparing different access cavity configurations. METHODS: A µCT scan is used to develop a full 3D NURBS geometric solid model of a ceramic crown. Three different access cavity configurations are created virtually in the geometric model and there are then imported into proprietary finite element software. A linear analysis of the each crown is carried out under appropriate in vivo loading and the results are post-processed to carry out a quantitative comparison of the three configurations RESULTS: The geometric model is shown to be a flexible and quick way of simulation access cavities. Preliminary indications are that post processed strain results from the finite element analysis are good comparators of competing access cavity configurations. SIGNIFICANCE: The generation of geometric solid models of dental crowns from µCT scans is a flexible and efficient methodology to simulate a number of access cavity configurations. Furthermore, advanced post-processing of the primary finite element analysis results is worthwhile as preliminary results indicate that improved quantitative comparisons between different access cavity configurations are possible.

The effect of variability in the powder/liquid ratio on the strength of zinc phosphate cement.

Aim. To investigate (a) variability in powder/liquid proportioning and (b) effect of variability on diametral tensile strength (DTS), in a zinc phosphate cement. Statistical analyses (α = 0.05) were by Student's t-test in the case of powder/liquid ratio and one-way ANOVA and Tukey HSD for pair-wise comparisons of mean DTS. The Null hypotheses were that (a) the powder-liquid mixing ratios would not differ from the manufacturer's recommended ratio (b) DTS of the set cement samples using the extreme powder/liquid ratios would not differ from those made using the recommended ratio. Methodology. 34 dental students dispensed the components according to the manufacturer's instructions. The maximum and minimum powder/liquid ratios, together with the manufacturer's recommended ratio, were used to prepare samples for DTS testing. Results. Powder/liquid ratios ranged from 2.386 to 1.018. The mean ratio (1.644) was not significantly different from the recommended value of 1.718 (P = 0.189). DTS values for the maximum and minimum ratios were both significantly different from each other (P < 0.001) and from the mean value obtained from the recommended ratio (P < 0.001). Conclusions. Variability exists in powder/liquid ratio for hand dispensed zinc phosphate cement. This variability can affect the DTS of the set material.