An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice.

OBJECTIVE: To investigate the puncture resistance of a recently introduced non-latex, nitrile dental glove in comparison with a latex glove worn during routine clinical dental procedures. SETTING: Dentists in general dental practice working within the UK during 1999. SUBJECTS AND METHODS: 2,020 gloves worn by five general dental practitioners were examined for punctures following standard clinical use by a water inflation method. Procedures undertaken during glove usage and length of time worn were recorded. RESULTS: Following clinical use, 1.9% of the latex gloves and 5.3% of the nitrile gloves had punctures, a statistically significant difference (P < 0.0001). The puncture resistance of the nitrile gloves was superior to the puncture resistance of previously tested worn non-latex (vinyl) gloves. There was no evidence of a statistically significant difference between operators for the percentage or incidence of punctured gloves (P = 0.787) after correcting for glove type. No statistically significant difference was noted between incidence of puncture in the control, unused gloves (n = 200 for each type) and the gloves examined following clinical use (P = 0.907 for nitrile, P = 0.613 for latex). CONCLUSION: No increase in the number of punctures was noted following clinical use for either glove type. This could be considered to indicate good puncture resistance of the gloves tested in clinical use.

Peer review amongst restorative specialists on the quality of their communication with referring dental practitioners.

OBJECTIVE: A peer review study was carried out to assess the written communication between consultants and specialist registrars in restorative dentistry with the referring general dental practitioners. METHODS: Seven people took part in the study and each presented referral and reply letters for five patients whom they had seen for consultation. The referral letters were used for information only and were not used in the peer review process. Each participant inspected the referral and reply letters from the other six participants. The reply letters were anonymously peer reviewed by using a proforma containing agreed criteria in relation to appropriate factors to include in the reply letter. The reviewer also ranked the letter in relation to overall quality on a 1-10 point scale. RESULTS: It was found that the participants' letters generally conformed positively with the agreed criteria although there were some differences between individuals. There were particular problems identified in relation to tooth notation. Reply letters commonly used different forms of tooth notation to the referring practitioners. CONCLUSIONS: The ranking of the letters generally indicated that the participants' replies were judged to be favourable by their peers. There may be scope for continuing this study in relation to peer review by other groups of professionals, in particular practitioners in primary dental care.

A prospective survey of secondary care tooth wear referrals: demographics, reasons for concern and referral outcomes.

AIM: To provide a descriptive investigation of general dental practitioners' (GDPs) referrals to Glasgow Dental Hospital and School for management of tooth wear. MATERIALS AND METHODS: One hundred and twenty-four patient-referrals were reviewed over a 12 month period. A questionnaire was also completed by patients and three reviewing consultants to identify patient demographics, patient perception, consultant's diagnosis and referral outcome. RESULTS: Overall survey return-rate was 67% of 124 included referrals. Males represented 72% of referrals compared to 28% for females (p = 0.001). A significant percentage of patients inhabited the most-deprived areas (59%, p = 0.002). Sixty-one percent of patients were aware of their tooth wear within the past five years. Aesthetics was the primary concern for 54% of patients (p = 0.001). Attrition was the main aetiology of tooth wear in 51% of referrals (p = 0.001). Ninety-two percent of patients (n = 76/83) did not require specialist treatment and were consequently returned to their GDP, referred for hypnotherapy or reviewed later. CONCLUSION: There was a significant association between social deprivation and tooth wear in GDP referrals to a secondary care dental facility. Males aware of their tooth wear for the preceding five years, presenting with appearance as their main complaint and displaying evidence of attrition were more likely to be referred by GDPs for specialist management or advice.

Availability of manufacturers' information on efficacy and compatibility of detergents used for cleaning dental instruments.

AIM: To review physico-chemical data supplied for commercially available detergents marketed for manual and/or ultrasonic cleansing of reusable dental instruments. METHOD: Manufacturers/suppliers of commercially available detergents for manual or ultrasonic cleaning of dental instruments within primary dental care were invited to supply product information. A structured questionnaire requested details on a range of physical and chemical properties for each detergent. RESULTS: Seventeen detergent manufacturers/suppliers, encompassing 31 commercially available detergents were identified. Ten of the 17 manufacturers provided information on 23 (74%) of the detergent formulations. Nine detergents were of neutral pH, ten mild alkalis (pH 7.5-10.5) and four strong alkalis (pH >10.5). Sixteen detergents were recommended for ultrasonic and manual cleaning, four stated ultrasonic use and three manual only. Ten detergents cited enzymatic activity as their main mode of action, but only six manufacturers provided detailed information. Four detergents recommended by manufacturers as suitable for manual washing had a strong alkaline pH (>10.5), presenting chemical hazards to users. Two strong alkaline detergents did not warn users of potential adverse effects of such alkaline solutions (corrosion) upon aluminium containing instruments. Only one detergent had investigated the potential toxicity of detergent residuals remaining on instruments after reprocessing. CONCLUSION: It has proven challenging to collate physico-chemical data on detergents suitable for use in manual and/or ultrasonic cleaning of dental instruments in general dental practice. Standardisation of information on the nature and efficacy of dental detergents in a readily accessible form would be beneficial to dental practice.

A review of dental implants and infection.

Dental implants have become increasingly common for the management of tooth loss. Despite their placement in a contaminated surgical field, success rates are relatively high. This article reviews dental implants and highlights factors leading to infection and potential implant failure. A literature search identified studies analysing the microbial composition of peri-implant infections. The microflora of dental peri-implantitis resembles that found in chronic periodontitis, featuring predominantly anaerobic Gram-negative bacilli, in particular Porphyromonas gingivalis and Prevotella intermedia, anaerobic Gram-negative cocci such as Veillonella spp. and spirochaetes including Treponema denticola. The role of Staphylococcus aureus and coagulase-negative staphylococci that are typically encountered in orthopaedic infections is debatable, although they undoubtedly play a role when isolated from clinically infected sites. Likewise, the aetiological involvement of coliforms and Candida spp. requires further longitudinal studies. Currently, there are neither standardised antibiotic prophylactic regimens for dental implant placement nor universally accepted treatment for peri-implantitis. The treatment of infected implants is difficult and usually requires removal. In the UK there is no systematic post-surgical implant surveillance programme. Therefore, the development of such a project would be advisable and provide valuable epidemiological data.

Care home staff knowledge of oral care compared to best practice: a West of Scotland pilot study.

AIM: To evaluate care home (N) staff knowledge of oral care provision for dependent older people in comparison to guidelines from NHS Quality Improvement Scotland (NHSQIS). This pilot study also aimed to identify barriers to delivering oral care and determine if oral health educator (OHE) training had an effect upon staff knowledge of oral care delivery. SETTING: This cross-sectional analytic investigation was undertaken within the Greater Glasgow & Clyde area between 2005 and 2007. METHODS: From 33 care homes (N), 28 participated in data gathering through an interview schedule involving 109 staff. A 'knowledge check-list' founded upon daily oral care guidelines from the NHSQIS best practice statement (BPS) served as a template for knowledge assessment. An OHE undertook small group discussions related to the BPS in a sub-group of original participants and a second round of data was collected. RESULTS: The majority of surveyed staff (n = 86, 79%) agreed that residents required assistance with oral care and placed oral care (n = 85, 78%) in a moderate to high priority. However, only 57% of managers and 49% of nurses had received training in oral care provision. Most staff (79% of managers, 85% of nurses) were unaware of the NHSQIS BPS. Deficiencies in knowledge were identified in several areas of the BPS. In particular, knowledge in the care of the natural dentition was inadequate. Between pre- and post-OHE training, the research suggests the following areas are liable to change: prioritisation given to oral care (p = 0.01), perceived competence (p <0.0001) and confidence in providing oral care advice (p <0.0001). Following OHE intervention, staff knowledge in oral care procedures compliant with best practice guidelines increased by 45%. CONCLUSIONS: Knowledge of oral health provision by those responsible for the care of home residents was deficient. An OHE training programme structured around the NHSQIS BPS demonstrated a measurable increase in levels of staff knowledge of oral care procedures.

A survey of denture identification marking within the United Kingdom.

AIM: To assess the attitudes of healthcare workers within the UK towards identification marking of removable prostheses, and quantify the frequency with which this is currently undertaken. DESIGN: A postal questionnaire-based study. SETTING: The study was undertaken within the UK between 2002 and 2006 and surveyed prosthodontists working in a wide range of clinical settings. SUBJECTS AND METHODS: Questionnaires were sent to two sample groups: 1. Specialists in prosthodontics registered on the GDC specialist list; 2. Nursing staff in elderly care homes within the locality of Glasgow. RESULTS: Return rate of questionnaires from prosthodontic specialists was high, with 119 from 160 (74%) completed and returned. 54.9% of prosthodontic specialists carried out complete denture marking in their clinical practice and 40.9% undertook identification marking of partial removable prostheses. The vast majority (81.0%) of specialists indicated that denture identification marking was a worthwhile procedure. Furthermore, 68.9% thought the introduction of some form of guideline would be beneficial. Differences in the frequency of denture marking existed between varying clinical environments. Denture marking was not undertaken by healthcare workers within any of the surveyed care homes. CONCLUSION: The overwhelming opinion of prosthodontic specialists within the UK promotes the use of denture marking as a routine procedure.

Molecular-weight dependence of the glass transition temperature of freely-standing poly(methyl methacrylate) films.

We have used transmission ellipsometry to measure the glass transition temperature, T(g), of freely-standing films of atactic and syndiotactic poly(methyl methacrylate) (PMMA). We have prepared films with different molecular weights, MW, (159 x 10(3) < M (w) < 1.3 x 10(6)) and film thicknesses, h, ( 30 nm < h < 200 nm). For the high-MW ( M (w) > 509 x 10(3)) atactic PMMA films, we find that T(g) decreases linearly with decreasing h, which is qualitatively similar to previous results obtained for high-MW freely-standing polystyrene (PS) films. However, the overall magnitude of the T(g) reduction is much less (by roughly a factor of three) for the high-MW freely-standing PMMA films than for freely-standing PS films of comparable MW and h. The observed differences between the freely-standing PMMA and PS film data suggest that differences in chemical structure determine the magnitude of the T(g) reduction and we discuss the possible origins of these differences. Our analysis of the MW-dependence of the T(g) reductions suggests that the mechanism responsible for the MW-dependent T(g) reductions observed in the high-MW freely-standing films is different than that responsible for the MW-independent T(g) reductions observed in the low-MW freely-standing and supported films.

Root canal treatment and general health: a review of the literature.

REVIEW: The focal infection theory was prominent in the medical literature during the early 1900s and curtailed the progress of endodontics. This theory proposed that microorganisms, or their toxins, arising from a focus of circumscribed infection within a tissue could disseminate systemically, resulting in the initiation or exacerbation of systemic illness or the damage of a distant tissue site. For example, during the focal infection era rheumatoid arthritis (RA) was identified as having a close relationship with dental health. The theory was eventually discredited because there was only anecdotal evidence to support its claims and few scientifically controlled studies. There has been a renewed interest in the influence that foci of infection within the oral tissues may have on general health. Some current research suggests a possible relationship between dental health and cardiovascular disease and published case reports have cited dental sources as causes for several systemic illnesses. Improved laboratory procedures employing sophisticated molecular biological techniques and enhanced culturing techniques have allowed researchers to confirm that bacteria recovered from the peripheral blood during root canal treatment originated in the root canal. It has been suggested that the bacteraemia, or the associated bacterial endotoxins, subsequent to root canal treatment, may cause potential systemic complications. Further research is required, however, using current sampling and laboratory methods from scientifically controlled population groups to determine if a significant relationship between general health and periradicular infection exists.

An evaluation of the use of tooth temperature to assess human pulp vitality.

AIM: To evaluate change in tooth surface temperature following a thermal stimulus as a simple and reliable method to assess the presence and the extent of blood flow through teeth. METHODOLOGY: Miniature thermometers were used to measure the relationship between surface temperature of teeth and internal flow of 37 degrees C water (in vitro) or blood (in vivo). In addition, thermal stimuli were applied to the external surface of the teeth, and the rate of temperature recovery was related to internal flow. RESULTS: Under in vitro conditions, the surface temperature of teeth and rate of temperature recovery were related to the rate of internal water flow. However, in vivo neither standing surface temperature (P = 0.47) nor rate of temperature recovery (P = 0.19) were significantly related to evidential pulp vitality. CONCLUSION: Change in the surface temperature of teeth is not suitable as a simple clinical means to assess pulp vitality.