Artificial Synthesis of Conjugated Microporous Polymers via Sonogashira-Hagihara Coupling.

Amorphous network materials are becoming increasingly important with applications, for example, as supercapacitors, battery anodes, and proton conduction membranes. The design of these materials is hampered by the amorphous nature of the structure and sensitivity to synthetic conditions. Here, we show that through artificial synthesis, fully mimicking the catalytic formation cycle, and full synthetic conditions, we can generate structural models that can fully describe the physical properties of these amorphous network materials. This opens up pathways for the rational design where complex structural influences, such as the solvent and catalyst choice, can be taken into account.

Unravelling the mysteries of predatory conferences.

The science and practice of dentistry are underpinned by research and clinical developments that have been evaluated rigorously before being presented to the profession in peer-reviewed journals or at national and international meetings. The online platform that supports open access journals has been corrupted by the emergence of so-called 'predatory journals', which accept papers on payment of a significant publication fee. This practice has now extended to dental conferences and this article describes the author's personal views of predatory conferences.

Clinical research in primary dental care.

Many commissioning bodies for research expect that researchers will actively involve the public and patients in their projects. The National Institute for Health Research (NIHR), for example, involves members of the public in reviewing funding applications and making recommendations about research funding. The NIHR's portfolio is currently operating in 97% of NHS Trusts and this now includes research sited in primary dental care. This paper presents some case studies of these and other projects which are designed specifically for patient benefit in dental services in the community. This means there is no necessity to translate the outcomes of such research from a university or hospital base to the general population as the projects are undertaken in dental practices that provide primary dental care to (predominantly) NHS patients. The relevance of the outcomes to dental care is, therefore, likely to be of direct interest and importance to commissioners of healthcare funding in the UK who have a duty to use evidence bases for commissioning decisions.

Periodontology in the undergraduate curriculum in UK dental schools.

INTRODUCTION: In 1980 the British Society of Periodontology published a series of educational goals which have guided periodontal curricula at UK dental schools. Further, a survey of UK dental schools evaluated aspects of teaching and learning in periodontology. The aims of this project were to identify teaching practices and assessments in periodontology and best practice which may be developed in the future. MATERIALS AND METHODS: A questionnaire was sent to dental schools who had participated in the previous survey. The questionnaire sought information on aspects of teaching and learning in periodontology: teaching manpower, curriculum structure, assessment, research opportunities for students and whether implantology is delivered in the undergraduate curriculum. RESULTS: There is consistency between the education providers with respect to teaching and learning in periodontology. Most are developing integrated learning between dental undergraduates and members of the dental team although there are opportunities for further development. Students are expected to have knowledge of complex treatments but are not expected to be competent at undertaking periodontal surgery nor placing and restoring implants. CONCLUSION: The findings confirm that there is considerable consistency between the education providers with respect to aspects of teaching and learning in periodontology.

Drugs, medications and periodontal disease.

This paper reviews the effects that drugs may have on the gingival and periodontal tissues. Drug-induced gingival overgrowth has been recognised for over 70 years but is becoming a more prevalent occurrence with wider use of antihypertensive and immunosuppressant drugs. The anti-inflammatory steroids, non-steroidal drugs and anti-TNF-α agents might all be expected to exert a dampening effect on chronic periodontitis although the evidence is somewhat equivocal and none of these drugs has emerged as potentially valuable adjuncts to treat periodontal disease. Desquamative gingivitis is a clinical appearance of aggressive gingival inflammation with which a number of drugs have been associated and the oral contraceptives have also been implicated in the development of gingival inflammation. Patients who are prescribed bisphosphonates and anti-platelet drugs are at risk of serious side effects following more invasive dental procedures including extractions and surgical treatments although timely, conventional management of periodontal disease may be undertaken to reduce periodontal inflammation, prevent disease progression and ultimately the need for extractions.

Continuing professional development and application of knowledge from research findings: a qualitative study of general dental practitioners.

OBJECTIVES: To explore general dental practitioners' opinions about continuing professional development (CPD) and potential barriers to translating research findings into clinical dental practice. DESIGN: Qualitative focus group and interviews. SUBJECTS, SETTING AND METHODS: Four semi-structured interviews and a single focus group were conducted with 11 general dental practitioners in North East England. OUTCOME MEASURE: Transcripts were analysed using the constant comparative method to identify emergent themes. RESULTS: The key theme for practitioners was a need to interact with colleagues in order to make informed decisions on a range of clinical issues. For some forms of continuing professional development the value for money and subsequent impact upon clinical practice was limited. There were significant practice pressures that constrained the ability of practitioners to participate in certain educational activities. The relevance of some research findings and the formats used for their dissemination were often identified as barriers to their implementation in general dental practice. CONCLUSIONS: There are a number of potential barriers that exist in general dental practice to the uptake and implementation of translational research. CPD plays a pivotal role in this process and if new methods of CPD are to be developed consideration should be given to include elements of structured content and peer review that engages practitioners in a way that promotes implementation of contemporary research findings.

An endodontic conundrum: the association between pulpal infection and periodontal disease.

This paper reviews the classification of periodontal-endodontic lesions and considers the pathways through which inflammatory lesions or bacteria may communicate between the pulp and the periodontium. Such communications have previously underpinned the classification of periodontal-endodontic lesions but a more up-to-date approach is to focus specifically on those lesions that originate concurrently as pulpal infection (and necrosis) and periodontal disease on the affected teeth. In doing so, both conventional periodontal and endodontic treatments are indicated for the affected teeth, although more complex management strategies may occasionally be indicated.

Impact of a customised dietary intervention on antioxidant status, dietary intakes and periodontal indices in patients with adult periodontitis.

BACKGROUND: Dietary modification may be important in the prevention and control of chronic adult periodontitis. The role of promoting an adequate consumption of fruits, vegetables and whole grains in chronic periodontitis has not been thoroughly investigated. The main aim of this dietary intervention study was to assess the influence of a customised dietary intervention (aiming to increase the consumption of fruits, vegetables and whole grains) on antioxidant status in adults with chronic periodontitis. METHODS: Fifty-one participants, aged 30-65 years, were recruited from a U.K. Dental Hospital and randomly allocated to an intervention or control group. Both groups received normal clinical treatment but customised dietary advice was delivered to the intervention group by a community nutrition assistant. Dietary intakes, anthropometric parameters and biochemical indices with respect to blood and saliva and periodontal indices were evaluated at baseline, as well as at 3 and 6 months post-dietary intervention. RESULTS: At 3 and 6 months post-intervention, the intervention group showed a significant (P < 0.05) increase in plasma total antioxidant capacity measured by Trolox equivalent antioxidant capacity assay compared to the control group. At 3 and 6 months after dietary intervention, the intervention group had significantly higher intakes of fruits and vegetables compared to the control group. The intake of whole grain was significantly higher in the intervention group than in the control group, 6 months post-intervention. No significant differences were observed with respect to periodontal indices between groups. CONCLUSIONS: It is suggested that dietary advice may help to improve dietary habits and, consequently, the antioxidant status of patients with chronic periodontitis. However, the impact of such intervention on periodontal indices needs further investigation.

Outcomes of non-surgical periodontal treatment by dental hygienists in training: impact of site- and patient-level factors.

OBJECTIVES: To investigate the site- and patient-level factors that impact on the response to non-surgical periodontal therapy in patients with chronic periodontitis. METHODS: A retrospective evaluation of clinical outcomes following non-surgical periodontal therapy delivered by dental hygienists in training was undertaken. Case notes from 195 patients with chronic periodontitis were reviewed and clinical data pre- and post-treatment abstracted. Patients were categorized as 'responders' or 'non-responders' according to defined outcome criteria, and the relationship between clinical and demographic variables and treatment outcomes was assessed. RESULTS: Overall, there was a good response to the periodontal treatment. At deep sites (those with pretreatment probing depth ≥5 mm), the mean probing depth reduction was 1.6 ± 0.9 mm. Seventy-one (36%) patients were classified as non-responders (indicating that at least 30% of their deep sites did not improve by at least 2 mm following treatment). The non-responding group contained a significantly greater proportion of smokers (28%) than the responding group (16%). Plaque scores did not differ significantly between responders or non-responders either pre- or post-treatment. Regression analyses indicated that smoking status (odds ratio, OR: 2.04), mean pretreatment probing depth (OR: 1.49) and percentage of deep sites ≥5 mm at pretreatment (OR: 1.02) were significantly associated with response to treatment. CONCLUSION: This study supports the benefits of non-surgical therapy in the treatment of chronic periodontitis by dental hygienists in training. Better responses to treatment tend to be observed in non-smokers and in those with less advanced periodontitis at baseline.

Smoking cessation alters subgingival microbial recolonization.

Smoking cessation improves the clinical manifestations of periodontitis; however, its effect on the subgingival biofilm, the primary etiological agent of periodontitis, is unclear. The purpose of this study was to investigate, longitudinally, if smoking cessation altered the composition of the subgingival microbial community, by means of a quantitative, cultivation-independent assay for bacterial profiling. Subgingival plaque was collected at baseline, and 3, 6, and 12 months post-treatment from smokers who received root planing and smoking cessation counseling. The plaque was analyzed by terminal restriction fragment length polymorphism (t-RFLP). Microbial profiles differed significantly between smokers and quitters at 6 and 12 months following smoking cessation. The microbial community in smokers was similar to baseline, while quitters demonstrated significantly divergent profiles. Changes in bacterial levels contributed to this shift. These findings reveal a critical role for smoking cessation in altering the subgingival biofilm and suggest a mechanism for improved periodontal health associated with smoking cessation.

Smoking cessation as a dental intervention--views of the profession.

OBJECTIVE: To undertake a questionnaire-based survey to determine the attitudes and activities of dental professionals in primary care in the Northern Deanery of the UK in relation to providing smoking cessation advice. METHODS: Questionnaires for dentists, hygienists and dental nurses were sent to hygienists to distribute to other members of the team. The information collected included: smoking status of the professionals and the practice; roles of the dental team in giving smoking cessation advice; levels of training received; and potential barriers to giving this brief intervention. RESULTS: Over 90% of practices were smoke-free environments and significantly more dental nurses (23%) were smokers compared to dentists (10%) and hygienists (7%) (p<0.01). The majority of dentists and hygienists enquired about smoking status of their patients and all three groups believed that hygienists and dentists should offer brief smoking cessation advice. Potential barriers to delivering smoking cessation advice were identified: lack of remuneration; lack of time; and lack of training. CONCLUSION: Dental teams in primary care are aware of the importance of offering smoking cessation advice and, with further training and appropriate remuneration, could guide many of their patients who smoke to successful quit attempts.

Smoking cessation advice for patients with chronic periodontitis.

BACKGROUND: There are limited data on the utility of dental professionals in providing smoking cessation counselling in the UK. OBJECTIVES: The purpose of this study was to determine quit rates for smokers with chronic periodontitis who were referred to a dental hospital for treatment. MATERIALS AND METHODS: Forty-nine subjects with chronic periodontitis who smoked cigarettes were recruited. All subjects received periodontal treatment and smoking cessation advice as part of an individual, patient-based programme provided by dental hygienists trained in smoking cessation counselling. Smoking cessation interventions included counselling (all patients), and some patients also received nicotine replacement therapy (NRT) and/or Zyban medication. Smoking cessation advice was given at each visit at which periodontal treatment was undertaken (typically four to six visits) over a period of 10-12 weeks. Smoking cessation advice was also given monthly during the programme of supportive periodontal care over the following nine months. Smoking status was recorded at three, six and 12 months and was confirmed with carbon monoxide (CO) monitors and salivary cotinine assays. RESULTS: Forty-one per cent, 33%, 29% and 25% of patients had stopped smoking at week four, months three, six and 12, respectively. Gender, age, the presence of another smoker in the household, and baseline smoking status (determined using subject-reported pack years of smoking) were not significant predictors of quit success (P < 0.05). Baseline CO levels were significantly associated with quit success, however, and were significantly higher in those subjects who continued to smoke compared to those subjects who were quitters at week four, month three and month six (P < 0.05). CONCLUSION: Success rates in quitting smoking following smoking cessation advice given as part of a periodontal treatment compared very favourably to national quit rates achieved in specialist smoking cessation clinics. The dental profession has a crucial role to play in smoking cessation counselling, particularly for patients with chronic periodontitis.

The effect of smoking on periodontal treatment response: a review of clinical evidence.

BACKGROUND: Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment. AIM AND METHOD: The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers. OBSERVATIONS: The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments. CONCLUSIONS: Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.

Measuring plaque in clinical trials: index or weight?

AIM: To explore the possibility of using plaque weight rather than plaque index as a more objective, clinical outcome measure in periodontal clinical trials. MATERIALS AND METHODS: The study initially recruited 12 healthy volunteers who abstained from tooth cleaning for 24 h on each of the three occasions and then for 48 h on each of a further three occasions to accumulate plaque. On a further three visits, the subjects abstained from tooth cleaning for 24 h and then brushed with a powered toothbrush for 2 min. A split-mouth design with target teeth was adopted and plaque was first scored separately on each side of the mouth using the Turesky modification of the Quigley and Hein plaque index. Post-brushing residual plaque was also scored after tooth cleaning. Inter-proximal plaque was dried, removed, pooled and weighed: on one side of the mouth from the entire inter-proximal surfaces; and from beneath the contact points on the contra-lateral side. RESULTS: Discriminant validity showed the index to have an advantage over weight in discerning between 24- and 48-h plaque deposits, and between 24-h plaque and post-brushing plaque. Test-retest validity confirmed that for repeated plaque growth, variability within subjects was greater than the variability between subjects. There was an association between plaque weight and plaque index although the regression lines were non-linear. CONCLUSION: There appears to be no significant advantage in using plaque weight in periodontal clinical trials.

The crossover design to evaluate the efficacy of plaque removal in tooth-brushing studies.

OBJECTIVES: To evaluate the crossover clinical trial design to assess plaque removal efficacy of the Sonicare Elite. MATERIAL AND METHODS: A single-cohort, 12-week, two-treatment, single-blind, crossover clinical trial recruited 45 subjects. Plaque was recorded using the modified Quigley and Hein index plaque index (PI). After screening, subjects used the toothbrush for 2 weeks and were reminded to abstain from tooth cleaning 12-18 h prior to appointments. At visit two, subjects were randomized to 2 or 2(1/2) min. brushing time. PIs was recorded pre- and post-brushing. Subjects brushed for the allocated time for a further 2 weeks. At visit 3, PIs were recorded pre- and post-brushing. Two weeks later, at visit 4, the subjects crossed over and the protocol was repeated. RESULTS: There was no evidence of a learning effect within each arm of the crossover. A significant period effect was detected; however, no significant treatment by period effect was found. 2(1/2) min. brushing removed more plaque at full mouth (p=0.037), smooth (p=0.012) and lingual (p=0.002) sites compared with 2 min. CONCLUSION: The crossover design is a valid model for assessing plaque removal efficacy in tooth-brushing studies where no carry-over effect is clinically plausible.

The effect of quitting smoking on chronic periodontitis.

OBJECTIVES: To evaluate longitudinally the effect of smoking cessation on clinical and radiographic outcomes following non-surgical treatment in smokers with chronic periodontitis. MATERIAL AND METHODS: Forty-nine smokers with chronic periodontitis who wished to quit smoking were recruited. Full-mouth probing depths, bleeding and plaque data were recorded at baseline, 3, 6 and 12 months. Clinical attachment levels were recorded at target sites and subtraction radiography was used to assess bone density changes. Patients received non-surgical periodontal therapy during the first 3 months and supportive periodontal care over the remainder of the study. Smoking cessation counselling was provided according to individual need. RESULTS: After 12 months, of patients with complete data, 10 had continuously quit smoking (20% of the original population), 10 continued smoking and six were oscillators (those patients who quit and then relapsed). There were no differences between the groups following treatment with respect to mean clinical or radiographic parameters. Analysis of probing depth reductions between baseline and month 12, however, and comparing quitters with the other two groups combined, demonstrated a significant difference in favour of quitters (p<0.05). Furthermore, quitters were significantly more likely to demonstrate probing depth reductions > or =2 and > or =3 mm than non-quitters and oscillators (p<0.05). CONCLUSION: Quitting smoking has an additional beneficial effect in reducing probing depths following non-surgical treatment over a 12-month period.

Assessing adherence with toothbrushing instructions using a data logger toothbrush.

OBJECTIVES: To evaluate patient compliance with toothbrushing instructions using a data logger and a brushing diary. METHODS: Dental patients were provided with powered toothbrushes modified to carry electronic data loggers. Demonstration of the most effective way to use the toothbrush was provided with instructions to brush for 2 minutes morning and evening. Data logger brushes were supplied for two episodes of 8 weeks. Brushing time was also recorded in a diary during episode 1. RESULTS: Data from 14 brushes (2,287 recordings) were used to evaluate compliance in episode 1 Nine brushes (1,526 recordings) were used in episode 2 A total of 2,333 brushing events were reported manually in the diaries. Data logger records during episode 1 showed that only 34% of events were compliant with the instruction of a 2 minute brushing time, 20% were partially compliant (within +/-30s of 2 minutes), and 46% of events were non-compliant (>30s from 2 minutes). The respective proportions for episode 2 were 24%, 24% and 52%. Diary data reported 58% of events as compliant with 42% non-compliant. CONCLUSIONS: Manually completed brushing diaries do not provide an accurate reflection of subjects' compliance with toothbrushing instructions.

Efficacy of plaque removal of the Sonicare Elite versus the Sonicare Advance from hard-to-reach sites.

OBJECTIVE: To compare the Sonicare Elite with the Sonicare Advance in terms of the reduction in supragingival plaque in the posterior, hard-to-reach areas of the mouth. METHOD: This was a single-cohort, 6-week, two-treatment, single-blind, cross-over clinical trial that recruited 45 subjects. Plaque scores were recorded throughout the study using a modification of the Quigley and Hein plaque index (PI). All subjects had a minimum pre-brushing PI of 1.8 at screening following 24 h abstention from tooth cleaning. Subjects then used a Sonicare Advance powered toothbrush at home for 4 weeks for familiarisation purposes. At the next visit (2), subjects were given either the Sonicare Elite or the Sonicare Advance powered toothbrush for a further 2 weeks of home use. Twenty-four hours prior to visit 3, subjects abstained again from tooth cleaning. At visit 3, the PI was recorded pre- and post-tooth brushing and then all remaining "mature" plaque was removed professionally with a dental prophylaxis. After a further period of 24 h (to accumulate new plaque) without tooth brushing the subjects returned for visit 4 at which PIs were again recorded pre- and post-tooth brushing. The subjects were then given the second toothbrush in the cross-over sequence and attended for visits 5 and 6 at which the protocol for visits 3 and 4 was repeated. RESULTS: The Sonicare Elite powered toothbrush was more effective than the Sonicare Advance model in removing both mature and newly formed plaque. The magnitude of the differences between the toothbrushes for all posterior sites, interproximal and smooth surfaces, respectively, was 0.35 U (p<0.001), 0.39 U (p<0.001) and 0.32 U (p<0.001) of the modified Quigley and Hein PI. There was no evidence of a significant period effect comparing data from visits 5 and 6 against those from visits 3 and 4. There was, however, a significant visit effect with full-mouth (p<0.01), interproximal (p<0.001) and smooth surface (p<0.01) post-brushing plaque scores being significantly lower at visits 4 and 6 than at visits 3 and 5. CONCLUSION: The data support the observation that the Sonicare Elite toothbrush is more effective than the Sonicare Advance model in removing both newly formed and mature plaque from all posterior, interproximal and smooth tooth surfaces.

A clinical comparison of an oscillating/rotating powered toothbrush and a manual toothbrush in patients with chronic periodontitis.

PRIMARY OBJECTIVE: To compare the relative efficacy of an oscillating/rotating powered toothbrush to that of a conventional manual toothbrush in a group of periodontal patients over a 16-month period with respect to plaque control. SECONDARY OBJECTIVE: To compare differences in pocket depth (PD) and bleeding index (BI) between the two groups over a 16-month period. MATERIAL AND METHODS: Forty patients were recruited to a 16-month, single-blind, two-group, randomised, parallel group clinical trial to compare the effects of manual and oscillating/rotating powered toothbrushes in a cohort of patients with chronic periodontitis. None of the patients had previous experience of using an oscillating/rotating brush and had a mean plaque index (PI) of > 2.0 (modified Quigley and Hein index) at baseline. Patients were stratified by gender, age and smoking status then randomised to using a manual or an oscillating/rotating brush for the duration of the study. Conventional non-surgical periodontal therapy was undertaken within the first month after baseline. PI was the primary outcome measure with PDs and BI also recorded at baseline and months 3, 6, 10 and 16. RESULTS: Mean full-mouth (FM) scores at baseline for oscillating/rotating brushing and manual brushing groups were as follows: PI, 3.4 and 3.5; BI, 1.7 and 1.5; and PD, 3.4 and 3.3. The mean reduction in FM scores from baseline to 16 months were: PI, 0.72 and 0.75; PD, 0.43 and 0.57; and BI, 0.74 and 0.83, respectively. Repeated measures ANOVA were used to compare differences between groups (adjusted for baseline levels) at months 3, 6, 10 and 16 and showed no statistically significant difference between groups for PI and PD (p > 0.05). A difference of 0.2 BI units was detected in favour of the manual brushing group (p = 0.04). CONCLUSION: Over a 16-month period, there were no differences in PI reduction or PD reduction between patients who underwent non-surgical management of chronic periodontal disease and used either an oscillating/rotating powered toothbrush or a conventional manual toothbrush. A difference in gingival bleeding reduction was detected in favour of the patients allocated the manual brush.