BSP Implementation of Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline.

OBJECTIVES: to adapt the supranational European Federation of Periodontology (EFP) Prevention and Treatment of Peri-implant Diseases - The EFP S3 Level Clinical Practice Guideline for UK healthcare environment, taking into account a broad range of views from stakeholders and patients. SOURCES: This UK version, based on the supranational EFP guideline [1] published in the Journal of Clinical Periodontology, was developed using S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 55 clinical recommendations for the Prevention and Treatment of Peri-implant Diseases, based on the classification for periodontal and peri-implant diseases and conditions [2]. METHODOLOGY: The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework, following the S3-process, the underlying evidence was updated and a representative guideline group of 111 delegates from 26 stakeholder organisations was assembled into four working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION: Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline for the Prevention and Treatment of Peri-implant Diseases was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK healthcare community including the public. CLINICAL SIGNIFICANCE: The S3-level-guidelines combine evaluation of formal evidence, grading of recommendations and synthesis with clinical expertise of a broad range of stakeholders. The international S3-level-guideline was implemented for direct clinical applicability in the UK healthcare system, facilitating a consistent, interdisciplinary, evidence-based approach with public involvement for the prevention and treatment of peri-implant diseases.

A 3D In-vitro model of the human dentine interface shows long-range osteoinduction from the dentine surface.

Emerging regenerative cell therapies for alveolar bone loss have begun to explore the use of cell laden hydrogels for minimally invasive surgery to treat small and spatially complex maxilla-oral defects. However, the oral cavity presents a unique and challenging environment for in vivo bone tissue engineering, exhibiting both hard and soft periodontal tissue as well as acting as key biocenosis for many distinct microbial communities that interact with both the external environment and internal body systems, which will impact on cell fate and subsequent treatment efficacy. Herein, we design and bioprint a facile 3D in vitro model of a human dentine interface to probe the effect of the dentine surface on human mesenchymal stem cells (hMSCs) encapsulated in a microporous hydrogel bioink. We demonstrate that the dentine substrate induces osteogenic differentiation of encapsulated hMSCs, and that both dentine and ß-tricalcium phosphate substrates stimulate extracellular matrix production and maturation at the gel-media interface, which is distal to the gel-substrate interface. Our findings demonstrate the potential for long-range effects on stem cells by mineralized surfaces during bone tissue engineering and provide a framework for the rapid development of 3D dentine-bone interface models.

Why don't dental teams routinely discuss dentine hypersensitivity during consultations? A qualitative study informed by the Theoretical Domains Framework.

AIM: Although dentine hypersensitivity is widespread, can cause substantial pain and impact quality of life, it is not routinely discussed during dental consultations. This qualitative study aimed to develop an understanding of the barriers and facilitators to these discussions. MATERIALS AND METHODS: Using the Theoretical Domains Framework to shape the topic guide, N = 7 online focus groups were organized with a total N = 40 participants comprising experienced dentists, dental foundation trainees and dental care professionals. Inductive and deductive thematic analyses of the anonymized, transcribed focus group conversations were undertaken. RESULTS: An attitude-behaviour gap was observed in dental teams' accounts. Although they saw it as part of their professional role to routinely discuss sensitivity, and believed that such conversations were 'an easy win', in practice they experienced several behavioural barriers that hindered these conversations from taking place. These included competing priorities, a perceived lack of seriousness and assessment of dentine hypersensitivity and practical issues such as time. CONCLUSIONS: Systemic (e.g., lack of time and training, professional culture) and behavioural (e.g., dental teams' belief that conversations should take place only with patients likely to be adherent) barriers to dentine hypersensitivity conversations explain why these conversations do not routinely take place.

Patient-reported understanding and dentist-reported management of periodontal diseases - a survey: do you know what gum disease is?

Introduction Mild-to-moderate gingivitis is treatable by effective toothbrushing with appropriate over-the-counter oral health care products; however, rates remain high.Aim To determine patient knowledge of gingivitis and dentists' views on management.Methods Surveys were completed by dentists and dental hospital patients.Results In total, 224 patients and 50 dentists participated. Clinical health, gingivitis, or periodontitis was detected in 2%, 33% and 56% of patients, respectively; 32% reported never suffering gingival bleeding. Moreover, 74% of patients reported gingival health as very important but only 53.7% with gingivitis occasionally/often were moderately-extremely worried about their symptoms. More than 50% of patients knew gingivitis causes poor oral health but <20% knew it elevated risks of other systemic conditions. Patients thought education on risks associated with poor oral health and product recommendations were most likely, and daily reminders least likely, to improve compliance with oral health advice (OHA). Also, 40% of dentists thought their patients were relatively unaware of the importance of gingival health, 76.9% of their patient-base had gingivitis, and 96% give OHA to these patients but only 30% thought this effected improvement. The most useful tools for improving oral health were better patient knowledge of the consequences and one-to-one instruction.Conclusion Patients struggle to attain oral health following OHA. Education about gingivitis-associated risks might improve OHA compliance.

Comparing estimates of household expenditures between pictorial diaries and surveys in three low- and middle-income countries.

In most low- and middle-income countries (LMICs), household out-of-pocket (OOP) health spending constitutes a major source of healthcare financing. Household surveys are commonly used to monitor OOP health spending, but are prone to recall bias and unable to capture seasonal variation, and may underestimate expenditure-particularly among households with long-term chronic health conditions. Household expenditure diaries have been developed as an alternative to overcome the limitations of surveys, and pictorial diaries have been proposed where literacy levels may render traditional diary approaches inappropriate. This study compares estimates for general household and chronic healthcare expenditure in South Africa, Tanzania and Zimbabwe derived using survey and pictorial diary approaches. We selected a random sub-sample of 900 households across urban and rural communities participating in the Prospective Urban and Rural Epidemiology study. For a range of general and health-specific categories, OOP expenditure estimates use cross-sectional survey data collected via standardised questionnaire, and data from these same households collected via two-week pictorial diaries repeated four times over 2016-2019. In all countries, average monthly per capita expenditure on food, non-food/non-health items, health, and consequently, total household expenditure reported by pictorial diaries was consistently higher than that reported by surveys (each p<0.001). Differences were greatest for health expenditure. The share of total household expenditure allocated to health also differed by method, accounting for 2% in each country when using survey data, and from 8-20% when using diary data. Our findings suggest that the choice of data collection method may have significant implications for estimating OOP health spending and the burden it places on households. Despite several practical challenges to their implementation, pictorial diaries offer a method to assess potential bias in surveys or triangulate data from multiple sources. We offer some practical guidance when considering the use of pictorial diaries for estimating household expenditure.

A randomised controlled trial evaluating the impact of oral health advice on gingival health using intra oral images combined with a gingivitis specific toothpaste.

OBJECTIVES: Does a complex intervention of oral hygiene advice (OHA) delivered with intra-oral scanner images, anti-gingivitis toothpaste and motivational reminders, improve oral health more than a standard of care control arm of fluoride toothpaste, with OHA without scanner images? METHODS: Adult participants with pre-existing gingivitis were randomised to intervention or control. Following enrolment, baseline and each subsequent visit (V) (3-weeks, V2; 3-months, V3; 6-months, V4) followed the same schedule. Bleeding on Probing (BOP) was assessed and Intra Oral Scan IOS(1) recorded. Plaque was disclosed, scored and re-scanned (IOS(2)). The intervention group received OHA with IOS images, control group receiving OHA without IOS images. Participants brushed with their allocated toothpaste (fluoride, control; anti-gingivitis, intervention), IOS(3) was recorded. Between visits participants brushed with their allocated toothpaste, intervention group received motivational reminders. RESULTS: BOP scores from baseline were significantly improved in the intervention group compared to control at all visits for all surfaces (p<0.001); differences at V4 were 0.292 (all), 0.211 (buccal/labial) and 0.375 (lingual/palatal). Plaque scores from baseline pre-brushing to each visit pre- and post-brushing also favoured the intervention group, the difference always significant on lingual/palatal surfaces (p<0.05), significant for all but pre-brushing-V4 (p<0.05) on all surfaces, but only significant for pre-brushing-V3 (p<0.05) buccally/labially. Differences from baseline to post-brushing at V4 were: 0.200 (all), 0.098 (buccal/labial) and 0.291 (lingual/palatal). CONCLUSION: A complex intervention comprising OHA delivered with IOS-images, anti-gingivitis toothpaste and motivational reminders improved gingival health more than existing standard of care-OHA together with a standard fluoride toothpaste over a 6-month period. CLINICAL SIGNIFICANCE STATEMENT: Intra-oral scans (IOS) are now frequently used in general dental practice for a variety of purposes. IOS use, in combination with motivational texts and an anti-gingivitis toothpaste, could be further deployed to promote oral hygiene behaviour change in patients and improve gingival health, in a cost-effective manner.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis.

OBJECTIVES: This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain. STUDY SELECTION: Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions. CONCLUSIONS: Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies. CLINICAL RELEVANCE: This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

Clinical trials evaluating desensitising agents. Some design and analysis issues.

INTRODUCTION: The purpose of this short communication is to draw attention to an efficient design for trials to evaluate desensitising agents, and an appropriate statistical analysis. METHODS: Two recent sensitivity trials conducted by the Bristol Dental School Clinical Trials Group are reviewed. RESULTS: The methodology used was effective to establish efficacy of the products evaluated. CONCLUSIONS: This methodology is recommended for wider use. CLINICAL SIGNIFICANCE: Effective clinical trial methodology enables establishment of efficacy of desensitising products leading to patient benefit.

High resolution 16S rRNA gene Next Generation Sequencing study of brain areas associated with Alzheimer's and Parkinson's disease.

Introduction: Alzheimer's (AD) and Parkinson's disease (PD) are neurodegenerative conditions characterized by incremental deposition of ß-amyloid (Aß) and α-synuclein in AD and PD brain, respectively, in relatively conserved patterns. Both are associated with neuroinflammation, with a proposed microbial component for disease initiation and/or progression. Notably, Aß and α-synuclein have been shown to possess antimicrobial properties. There is evidence for bacterial presence within the brain, including the oral pathobiont Porphyromonas gingivalis, with cognitive impairment and brain pathology being linked to periodontal (gum) disease and gut dysbiosis. Methods: Here, we use high resolution 16S rRNA PCR-based Next Generation Sequencing (16SNGS) to characterize bacterial composition in brain areas associated with the early, intermediate and late-stage of the diseases. Results and discussion: This study reveals the widespread presence of bacteria in areas of the brain associated with AD and PD pathology, with distinctly different bacterial profiles in blood and brain. Brain area profiles were overall somewhat similar, predominantly oral, with some bacteria subgingival and oronasal in origin, and relatively comparable profiles in AD and PD brain. However, brain areas associated with early disease development, such as the locus coeruleus, were substantially different in bacterial DNA content compared to areas affected later in disease etiology.

BSP implementation of the 2017 classification of periodontal diseases: a practice retrospective.

Introduction The new world classification of periodontal diseases and conditions was developed in 2017. The British Society of Periodontology and Implant Dentistry (BSP) implemented the classification in a series of papers published in the British Dental Journal in January 2019.Aims and objectives This study aimed to investigate if the BSP implementation was workable in general dental practice and to reveal if any lessons were learnt from its regular use two years following its release.Materials and methods This was a cross-sectional, retrospective, non-intervention analysis of a patient population (n = 891) drawn from a complete list of a private dental surgeon. Diagnostic and demographic data were drawn from the patient records, collated and analysed using SPSS Statistics v26.Results Diagnoses derived from the new classification were identified for 92% of subjects, indicating a high level of implementation. In total, 20.9% of subjects were diagnosed with periodontitis, and of these, 57% were unstable, 39% stable and 4% in remission. The mean bleeding on probing score across the cohort was 7.7%. Moreover, 76% of the non-periodontitis patients were diagnosed with 'clinical gingival health', 23% with localised gingivitis and 1% with generalised gingivitis.Conclusion The new classification has been found to be readily implemented in a general practice setting. Use of the new classification allows for close monitoring of periodontal status, and as a result, close monitoring of the effectiveness of pathways of care.

Personal and household PM2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries.

BACKGROUND: Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. OBJECTIVE: To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. METHODS: As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. RESULTS: The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) µg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10-5 m-1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. CONCLUSIONS: We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.

A pilot study to evaluate the impact of digital imaging on the delivery of oral hygiene instruction.

AIMS: To determine whether personalised Oral Hygiene Advice (OHA) using an intra-oral-camera (IOC) combined with standard OHA as provided in general dental practice reduces plaque levels after 4 weeks more than the provision of standard OHA. MATERIALS AND METHODS: 22 healthy adult participants diagnosed with gingivitis took part in this pilot parallel-designed, randomised, examiner-blind, 2x-treatment, study regarding their home-care oral hygiene habits and attitudes to oral health. An IOC-image was taken and plaque, gingival and bleeding scores were recorded. Test group participants received standard OHA with IOC-images to indicate areas for improvement, control group participants received standard OHA. Questionnaires and plaque, gingival and bleeding scores were repeated after 4 weeks. Plaque was scored from the IOC-images and scores compared to clinical plaque scores. RESULTS: Lifestyle habits, attitudes to oral health, plaque (0.63vs0.61, control vs test) and bleeding scores (1.17vs0.96, control vs test) were similar at baseline. After 4-weeks, plaque scores improved more in test as compared to control group (39.4vs20.6%, p<0.05, while gingival and bleeding scores approached significance. There was no difference in lifestyle habits between groups, but the test group reported significantly greater confidence in adhering to their bespoke oral health plan. Agreement between the clinical and IOC plaque scores was good. CONCLUSIONS: Use of IOC further personalises the prevailing standard of oral hygiene advice and generates great patient engagement with pictorial reports to facilitate a more in-depth patient explanation of their gingival health, resulting in significant plaque reduction and improved gingival health compared to the standard OHA alone.

European Federation of Periodontology Survey of Postgraduate and Specialist Training in Europe in 2020.

AIMS: The survey's aim was to establish which universities and other educational organisations deliver postgraduate and specialist training in Periodontology in the 31 countries who are members of the European Federation of Periodontology (EFP) and to obtain details of how these programmes are organised, funded, regulated and evaluated. METHODS: A questionnaire and covering letter were emailed to all national periodontal societies. The questions were on the name of country, official recognition, training programmes, entry to specialist training, specialist training assessment and recognition after completion of training. RESULTS: Twenty-nine (93%) of national periodontal societies responded. Key findings included the following: Periodontology was reported as being recognised at a national level in 17 countries, there was a three-year full-time programme in 12 countries, no fees were charged for specialist training in 10 countries, in 14 countries trainees received annual salaries, end of training (summative) assessments varied from country to country, 12 countries reported that they had a requirement for specialists in Periodontology to complete continuing education to maintain registration as specialists. CONCLUSIONS: This survey has established which universities and other educational organisations deliver postgraduate and specialist training in Periodontology and how these programmes are organised, funded, regulated and evaluated. To provide uniformly high-quality periodontal care for patients in all European countries, further harmonisation of postgraduate and specialty training in Periodontology would be advantageous.

Measuring and predicting personal and household Black Carbon levels from 88 communities in eight countries.

Black Carbon (BC) is an important component of household air pollution (HAP) in low- and middle- income countries (LMICs), but levels and drivers of exposure are poorly understood. As part of the Prospective Urban and Rural Epidemiological (PURE) study, we analyzed 48-hour BC measurements for 1187 individual and 2242 household samples from 88 communities in 8 LMICs (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Light absorbance (10-5 m-1) of collected PM2.5 filters, a proxy for BC concentrations, was calculated via an image-based reflectance method. Surveys of household/personal characteristics and behaviors were collected after monitoring. The geometric mean (GM) of personal and household BC measures was 2.4 (3.3) and 3.5 (3.9)·10-5 m-1, respectively. The correlation between BC and PM2.5 was r = 0.76 for personal and r = 0.82 for household measures. A gradient of increasing BC concentrations was observed for cooking fuels: BC increased 53% (95%CI: 30, 79) for coal, 142% (95%CI: 117, 169) for wood, and 190% (95%CI: 149, 238) for other biomass, compared to gas. Each hour of cooking was associated with an increase in household (5%, 95%CI: 3, 7) and personal (5%, 95%CI: 2, 8) BC; having a window in the kitchen was associated with a decrease in household (-38%, 95%CI: -45, -30) and personal (-31%, 95%CI: -44, -15) BC; and cooking on a mud stove, compared to a clean stove, was associated with an increase in household (125%, 95%CI: 96, 160) and personal (117%, 95%CI: 71, 117) BC. Male participants only had slightly lower personal BC (-0.6%, 95%CI: -1, 0.0) compared to females. In multivariate models, we were able to explain 46-60% of household BC variation and 33-54% of personal BC variation. These data and models provide new information on exposure to BC in LMICs, which can be incorporated into future exposure assessments, health research, and policy surrounding HAP and BC.

Multinational prediction of household and personal exposure to fine particulate matter (PM2.5) in the PURE cohort study.

INTRODUCTION: Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM2.5 exposure models. METHODS: The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM2.5 kitchen concentrations (n = 2,365) and male and/or female PM2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM2.5 exposures. RESULTS: The final models explained half (R2 = 54%) of the variation in kitchen PM2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R2 = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM2.5 kitchen concentrations. Average national PM2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 µg/m3 (Chile); 55 µg/m3 (China)) and 12-fold among households primarily cooking with wood (36 µg/m3 (Chile)); 427 µg/m3 (Pakistan)). Average PM2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile). CONCLUSION: Using survey data to estimate PM2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.

Implementing the 2017 Classification of Periodontal and Peri-Implant Diseases - how are we doing in the South West region of the UK?

Background A new world classification of periodontal diseases and conditions was developed in 2017 and implemented throughout the United Kingdom by the British Society of Periodontology and Implant Dentistry.Method A retrospective audit was undertaken at Bristol Dental Hospital (BDH) (December 2019 to March 2020) to assess uptake of the new classification in referral letters and its implementation by staff. In total, 75 consecutive new patient referrals seen at BDH were manually searched for diagnosis/classification. Additionally, the 75 most recent referrals where both the referring practitioner and BDH staff used the 2017 classification were analysed for agreeability.Results Within South West England, there was a positive uptake of the new classification in general practice, with 85% of referrals using the 2017 periodontal classification. Further, 98% of patients attending BDH for periodontology consultations were diagnosed using the 2017 classification. Results indicate 50.7% and 57.3% agreement for staging and grading, respectively, when comparing consultants to referring clinicians.Discussion The new classification has been widely conveyed to the profession and is being adopted quickly by specialists, general practitioners and dental health professionals. There is an underestimation of both stage and grade by referring practitioners, with 40% of referrals underestimating the stage and 38.7% underestimating the grade.

Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health.

AIMS: To determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated. MATERIALS AND METHODS: NHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months. RESULTS: A total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215). CONCLUSIONS: Behaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care. CLINICAL SIGNIFICANCE: Plaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.

A randomised controlled trial to compare the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste with a control toothpaste for the prevention of dentine hypersensitivity.

OBJECTIVES: To determine the efficacy of a cosmetic aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for the reduction of dentine hypersensitivity (DH) pain as compared to a control toothpaste containing potassium nitrate. METHODS: The study was a randomised, examiner-blind, two treatment arm, parallel controlled trial in healthy adults with at least 2 sensitive teeth (Schiff >2). At baseline, immediately after treatment and at 7 and 14 days of twice-daily brushing of the test or control toothpaste the sensitivity of 2 test teeth was measured following iced-water (Schiff and VAS) and tactile (Yeaple probe) stimuli, and a whole mouth plaque score was obtained. Participants also completed a whole-mouth VAS and DHEQ15 quality of life questionnaire at baseline, 7 and 14 days. RESULTS: Both toothpastes reduced DH in test teeth, but pain reduction in the test group was significantly better at all timepoints and by all measures (p = 0.005, tooth-level VAS immediately after brushing; p < 0.001 all other comparisons). There was a relative risk reduction of Schiff sensitivity of 55 % immediately after brushing which rose to 81 % after 7 and 88.6 % after 14 days (all p < 0.001). There were no differences in plaque, whole mouth VAS or DHEQ15 scores at any time point. CONCLUSION: This study demonstrated the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste compared to a potassium nitrate control toothpaste for the prevention of dentine hypersensitivity both immediately and over a 2 week period. This agent appears to have potential for pain alleviation from the common oral pain condition of DH and further research is warranted. CLINICAL SIGNIFICANCE: DH pain, whilst transient in nature, is arresting in magnitude, affecting quality of life. Daily application of efficacious toothpastes can relieve DH pain however, as yet, there is no gold standard treatment. The results of this study support further investigation of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for DH management.

BSP implementation of European S3 - level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice.

OBJECTIVES: To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of periodontitis (stage I-III) to a UK healthcare environment, taking into account the views of a broad range of stakeholders, and patients. SOURCES: This UK version is based on the supranational EFP guideline (Sanz et al., 2020) published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, which combined the assessment of formal evidence from 15 systematic reviews with a moderated consensus process of a representative group of stakeholders, and accounts for health equality, environmental factors and clinical effectiveness. It encompasses 62 clinical recommendations for the treatment of stage I-III periodontitis, based on a step-wise process mapped to the 2017 classification system. METHODOLOGY: The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. This framework allows for the adoption (unmodified acceptance), adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying systematic reviews were updated and a representative guideline group of 75 delegates from 17 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly. RESULTS AND CONCLUSION: Using the ADOLOPMENT protocol, a UK version of the EFP S3-level clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the dental community in the UK. CLINICAL SIGNIFICANCE: The aim of S3-level guidelines is to combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations. Herein, the first major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare system.

Randomised controlled trial of a microneedle patch with a topical anaesthetic for relieving the pain of dental injections.

OBJECTIVES: To determine whether a microneedle patch combined with 5% topical lidocaine reduces dental injection pain more than a patch without microneedles combined with 5% topical lidocaine. METHODS: This proof of principle randomised, two-treatment, double-blind, crossover split-unit design study in 16 healthy participants investigated levels of perceived pain from 3 increasing pain provoking challenges, when topical 5% lidocaine dental gel was applied to the oral mucosa with a microneedle patch and a patch with no microneedles, prior to infiltration with local anaesthesia on 2 visits. Pain was assessed by visual analogue scale (VAS) and 4-point verbal rating scale (VRS). RESULTS: 15 participants completed the study. Mean pain scores, lower at buccal sites, increased in both groups across challenges 1-3: Test palatal 5.1, 11.9, 26.8; buccal 0.7, 2.8, 18.3; Control palatal 12.3, 18.7, 39.5; buccal 4.0, 6.9, 30.6. The microneedle patch plus lidocaine significantly lowered VAS pain scores at both sites for all challenges, the biggest mean difference seen palatally after challenge 3 (12.7, p < 0.001). VRS pain scores were also significantly reduced for test compared to control for all 3 challenges (p = 0.014). Buccal scores favoured the microneedle patch, significantly for pain challenge 3 (p = 0.025). No adverse events occurred. CONCLUSIONS: Prior oral application of a microneedle patch combined with 5% topical lidocaine gel reduced the pain experienced from dental infiltration. Microneedle patch use in the dental setting offers the prospect of improving degree and depth of anaesthesia from topically applied anaesthetic gel, without itself causing any pain. CLINICAL SIGNIFICANCE: Dental injections are associated with fear and anxiety. Application of a microneedle patch, combined with topical anaesthetic, to the oral mucosa prior to delivery of the injection reduces the pain from this dental procedure. This novel technique may allay patients' apprehension of local anaesthesia and improve quality of life outcomes.