Effect of tobacco and nicotine in causing staining of dental hard tissues and dental materials: A systematic review and meta-analysis.

INTRODUCTION: Dental staining is a common concern for tobacco users. However, little is known about which components of tobacco are responsible for the staining and whether nicotine may be implicated. This is of increasing relevance with the popularity of novel products such as heated-tobacco products and electronic cigarettes (E-cigarettes). OBJECTIVES: This systematic review aimed to establish the evidence base for the effect if any, of the various tobacco and nicotine products in causing staining of dental hard tissues and materials. MATERIAL AND METHODS: This systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. There were four structured population intervention comparison outcomesquestions. A search was conducted up to December 2021 in three databases: MEDLINE, EMBASE, and Web of Science, and manual searching of relevant sources was also completed. Two researchers individually reviewed the titles then abstracts and finally full articles. A reporting quality appraisal was conducted appropriately to the study methodology. RESULTS: Of the 815 records titles identified, 56 full-text articles were assessed for eligibility, of which 27 were included for analysis. The included studies were mainly laboratory studies of varying reporting quality. There was evidence from 18 studies that tobacco exposure caused staining of dental hard tissues (pooled results from three studies- enamel/dentine; mean difference [MD]: 16.22; 95% confidence interval[12.11, 20.32; I2 : 96%)and materials (pooled result from four studies-resin composite; MD: 11.90; 95% CI: 11.47, 12.34; I2 : 100%). There was limited evidence that E-cigarettes 99%) and heated tobacco products (HTPs; pooled results from three studies--1.07, 6.54; I2 : 99%) cause staining, but this was lower than with traditional tobacco/found 11 compounds, of which 8 were terpenoids, from tobacco products implicated in causing staining. Finally, there was some evidence that resin composites stained more than other materials. CONCLUSIONS: Tobacco smoking causes dental staining. There was limited evidence that E-cigarettes and HTPs did cause dental staining that was less intense than that caused by traditional tobacco products.

Delivering to 'that list': the challenges of working with learning outcomes.

Dental education providers have raised concerns around the challenges experienced when trying to demonstrate student attainment of 'professionalism', as described in the General Dental Council (GDC) document 'Preparing for practice'. This manuscript describes a documentary analysis of each 'outcome' within the dentist professionalism domain section, with an assessment of whether it met the criteria of a functional learning outcome. In addition, outcomes were scrutinised in terms of application within undergraduate degree programmes. Key challenges identified were: the 'outcome list' included standards and objectives as well as outcomes; not all statements were specific and focused, some were broad and multi-faceted; determining attainment where there was no identifiable endpoints; and judging achievability within the supervised and confined environment of undergraduate programmes. We conclude that issues have been created through the way that these learning outcomes have been expressed. Also, it is evident that there are ideological and philosophical issues about accurately articulating the attainment of complex phenomena like professionalism. The findings from this study reflect the challenges associated with using learning outcomes to adequately capture professionalism, the values that underpin it and the behaviours that manifest its existence in clinical practice.

Obtaining patient feedback for quality assurance of undergraduate dental teaching.

Introduction In order to achieve the educational standards of the General Dental Council, providers of UK dental education programmes are required to demonstrate that feedback from patients is collected and used to inform programme development. Aims To determine areas of undergraduate dental training programmes that patients feel able to comment upon, allowing development of a patient feedback questionnaire. Methods Patients receiving treatment from undergraduate students were recruited to focus groups (n = 5, n = 6) where their experience of receiving student care was explored. Audio transcriptions were analysed for emergent themes. These themes informed the design of a questionnaire which was presented to a further patient focus group (n = 4) for content and face validity testing. Staff (n = 4) and student (n = 8) focus groups discussed its delivery. Results Patients were able to comment upon treatment quality, safety, the student-teacher interaction, and appointment times. An 18-question questionnaire was developed to include free text comments and answers on a visual analogue scale. It was modified following focus groups with patients, staff, and students. Conclusion Patients undergoing student treatment identified aspects of the clinical teaching programme that could be included in a feedback questionnaire. Following a pilot, the questionnaire will form part of the teaching quality assurance process.

Provision of information to patients on dental implant treatment: Clinicians' perspectives on the current approaches and future strategies.

OBJECTIVES: To explore 1) the approaches that are adopted by clinicians to give patients information in relation to dental implant treatment during clinical consultations; 2) clinicians' reflections on their current practices of implant information provision; and 3) clinicians' suggestions to improve future implant information provision. METHODS: A qualitative study employing face-to-face semi-structured interviews with eight clinicians working in UK secondary dental care. The data gathering and analysis followed the principles of qualitative thematic analysis. RESULTS: Clinicians reported that patients often hold misconceptions about dental implants, which are commonly acquired from generic information sources such as the media. This might be linked to high expectations regarding treatment outcomes and difficulties in communicating during clinical consultations. Clinicians were sometimes reluctant to voluntarily offer information about the longevity/ lifespan of implant supported restoration (ISR) and they had different opinions regarding the timing of information related to their long-term maintenance needs. Several strategies for improving the current practice of information giving in relation to dental implant treatment were suggested by clinicians. CONCLUSION: Providing accurate and timely information to patients could be challenging, although clinicians recognised the importance of doing so. As clinicians explained and debated their current approaches and reflected on their practices, they identified areas of potential improvement and ways to improve information provision related to dental implants. These were mainly focused on transforming patient care so that there is efficient co-operative alliance between patients and dental care providers. Considering upgrading information provision throughout the implant treatment pathway would transform this aspect of healthcare to make it more "patient-centred" than it is currently.

Patients' perceptions of implant placement surgery, the post-surgical healing and the transitional implant prostheses: a qualitative study.

OBJECTIVES: This study aimed to explore patients' thoughts, feelings about, and experiences of, implant placement surgery (IPS), the post-surgical healing stage and the immediate post-surgical transitional implant prosthesis (TIP) (fixed and removable). METHODS: A qualitative study design was chosen and 38 semi-structured telephone and face-to-face interviews were conducted with 34 patients at different stages of implant treatment. The interviews were transcribed verbatim; the data collection and coding process followed the principles of thematic analysis, which was facilitated through the use of NVivo10. RESULTS: Patients anticipated that surgery would be painful and unpleasant but were prepared to accept this temporary discomfort for the expected benefits of implant treatment. However, a key finding was that patients felt they had overestimated the trauma of surgery but underestimated the discomfort and difficulties of the healing phase. A number of difficulties were also identified with the TIP phase following implant surgery. CONCLUSION: Existing research has tended to focus on the longer term benefits of dental implant treatment. This qualitative study has investigated in-depth patients' perceptions of dental implant surgery, including their experiences related to sedation, and of transitional implant restoration. While patients felt their concerns were overestimated in relation to the implant surgery, they experienced greater morbidity than they expected in the healing phase. Recommendations are made for relatively small changes in care provision which might improve the overall patient experience. Partial dentate patients treated with a fixed transitional prosthesis experienced advantages more quickly than patients with an overdenture.

Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment.

OBJECTIVES: The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). METHODS: A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. RESULTS: There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. CONCLUSIONS: It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice.

Reducing the risk of failure in complete denture patients.

UNLABELLED: This paper aims to review the factors associated with an increased risk of failure in complete denture patients, based on the strength of the available evidence base. These include accuracy of jaw relations, a poorly formed mandibular ridge, poor quality dentures and patient neuroticism. Clinical strategies for overcoming these issues are described with particular reference to impression-taking and jaw relations. CLINICAL RELEVANCE: Identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.

Refusal of implant supported mandibular overdentures by elderly patients.

OBJECTIVE: The aim of this study was to gain greater in-depth understanding of why elderly patients who are currently dissatisfied with conventional dentures decline implant treatment. BACKGROUND: There is strong evidence from high-quality randomised controlled trials to support the use of implant-supported overdentures for the restoration of the edentulous mandible. However, whilst recruiting for randomised clinical trials, researchers have found that a high proportion of potential subjects decline participation, despite the removal of financial constraints. MATERIALS AND METHODS: The study adopted a qualitative approach to provide a rich and deep understanding of people's reasons for refusal. Data were collected through focus group interviews in a two-centre study based in Montreal, Canada and Newcastle, UK. A semi-structured interview schedule was used and iteratively developed as analysis identified themes from previous focus groups. Transcripts of focus groups were coded and emergent themes determined. RESULTS: Two main themes emerged; patients' fear and anxiety (relating to the pain of surgery, complications of the procedure and immediate post-surgical denture use), and the appropriateness of the procedure in an elderly person. CONCLUSIONS: Fears of pain, complications and social embarrassment, exacerbated by age, are important factors that help explain refusal of implants by elderly patients.

A pilot study examining the effects of enhanced aesthetics on oral health related quality of life and patient's satisfaction with complete dentures.

A randomised cross-over study with a validated assessment tool was used to assess patient satisfaction and oral health related quality of life after the delivery of two sets of dentures: one set had an enhanced aesthetics. There was a significant increase in patient satisfaction and oral health related quality of life when baseline data was compared with both types of replacement dentures. Some patients preferred the prostheses with enhanced aesthetics, although all patients reported significantly increased satisfaction with their new dentures; these findings are explored. No difference was seen in the outcome variables between the control and aesthetic dentures and sequence of delivery showed no difference.

The impact of dietary advice on edentulous adults' denture satisfaction and oral health-related quality of life 6 months after intervention.

OBJECTIVE: The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health-related quality of life (OHRQoL) in patients wearing implant-supported mandibular overdentures (IOD) or conventional dentures (CD). MATERIALS AND METHODS: In this prospective cohort study, 28 IOD (two implant-retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20-item oral health impact profile (OHIP-20) before and 6 months following provision of customised dietary advice. RESULTS: At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, + or - 15.6, vs. 68.7 + or - 15.6 P=0.001), stability (75.8 + or - 15.9 vs. 59.5 + or - 30.4, P=0.002), and perceived chewing ability (79 + or - 30.4 vs. 59.5 + or - 30.4, P=0.027) + or - when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. CONCLUSIONS: The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re-evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre-rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened.

Prognostic indicators for conventional complete denture therapy: a review of the literature.

OBJECTIVES: To review the current literature on prognostic indicators for conventional complete denture therapy. DATA: Original articles studying outcome measures and patient satisfaction with conventional complete dentures. SOURCES: Ovid databases from 1988 to present and subsequent review of related articles from the 1960s onwards. Searches were limited to English language only and used a variety of keywords. CONCLUSIONS: There remains a paucity of research in this area. From the best available data, construction of technically correct dentures, a well-formed mandibular ridge and accuracy of jaw relations are positive indicators for success. Patient neuroticism and a poorly formed mandibular ridge are negative indicators for success. Other prognostic indicators have not been shown to be of significant value. There exists a minority of patients who will never adapt to any conventional complete denture. This problem is more acute in the mandible than the maxilla. There is need for further research in this area.

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment. A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website. The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback. We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate. We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders.

Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment.

BACKGROUND: The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments--such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. METHODS/DESIGN: Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. DISCUSSION: Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements.

Correlation between finger-prick and venous ciclosporin levels: association with gingival overgrowth and hypertrichosis.

The aims of this study were (1) to ascertain ciclosporin C(2) levels currently being achieved in children with steroid-sensitive nephrotic syndrome (SSNS) and renal transplants (RTs), (2) to determine the feasibility of the use of finger-prick samples for the measurement of ciclosporin levels, and (3) to identify any correlation between hypertrichosis or gingival overgrowth (GO) and level of ciclosporin 2 h post-dose (C(2)). Seventy-two children (39 with SSNS, 33 with RT) participated. Ciclosporin 12 h trough (C(12)) and C(2) levels were measured in venous and finger-prick samples by high-performance liquid chromatography tandem mass spectroscopy. Photographs of the teeth and back were taken for assessment of GO and hypertrichosis. Mean (+/-SD) C(2) levels in the SSNS and RT groups were 512 (+/-181) microg/l and 471 (+/-229) microg/l. There was a highly significant relationship between venous and finger-prick ciclosporin levels (r(2) = 0.96, P < 0.0001). Fourteen children had severe GO. There was a small, though statistically significant, impact of ciclosporin level on GO (C(2) r(2) = 0.12, P = 0.003 and C(12) r(2) = 0.06, P = 0.038) but no correlation with dose (milligrammes per kilogramme per day or milligrammes per square metre per day) or duration. Seventeen children had moderate or severe hypertrichosis, this being more common in children of South Asian ethnicity (P < 0.0001). There was no correlation between ciclosporin exposure or duration and hypertrichosis. Finger-prick blood sampling may serve as a practical alternative to venepuncture in children receiving ciclosporin.

How do patients perceive the benefit of reconstructive dentistry with regard to oral health-related quality of life and patient satisfaction? A systematic review.

BACKGROUND: Reconstructive dentistry encompasses an enormous range of treatment modalities from the restoration of single teeth to the reconstruction of the whole dentoalveolar complex in edentulous patients. Some treatment modalities have been assessed in terms of quality-of-life (QoL) outcomes and satisfaction OBJECTIVES: The aim of the present investigation was to search and review studies published between 1996 and 2006 in which the impact of the treatment was measured in terms of QoL outcome, ideally, oral health-related quality of life (OHRQoL). Patient satisfaction was also accepted as an outcome. MATERIALS AND METHODS: The primary search engine used was NICB PubMed based on MeSH headings. Hand searching of the cited references in the included papers identified a number of additional studies. The primary focus of the search was to link treatment to QoL outcomes. RESULTS: The majority of included studies involved the treatment of edentulous patients, particularly the mandible. The preponderance of the studies comparing conventional dentures (CDs) and implant-supported overdentures (IODs) were randomized-controlled trials (N = 18). There was compelling evidence that patients were more satisfied with IODs than CDs. There was strong evidence that OHRQoL can be significantly improved using IODs. Evidence suggesting that one retention system is superior to another needs further clarification. Although high satisfaction ratings have been reported for maxillary implant prostheses, the overall ratings given to the maxillary implant prostheses were not significantly greater than for CDs. There was only sparce information regarding QoL or satisfaction outcomes for the majority of other forms of reconstructive dentistry. CONCLUSION: Apart from the restoration of the edentulous mandible with IODs or CD, where there is an accumulating body of evidence on the effect of treatment choice, there are many procedures for which there are little or no such data at all. As yet, the entire range of reconstructive treatment has witnessed insufficient investigations relating treatment to its effect on QoL or satisfaction. This is an area that needs to be expanded as a way of quantifying the effect of treatment choices.

Conventional rehabilitation of edentulous patients: the impact on oral health-related quality of life and patient satisfaction.

PURPOSE: This study examined patient satisfaction and oral health-related impacts on the quality of life of patients restored with complete conventional or duplicate dentures. MATERIALS AND METHODS: Forty patients (aged 55 to 85 years) were assigned to receive new complete maxillary and mandibular dentures using either a conventional or duplication technique according to clinical need. Patients rated their satisfaction with their dentures on 100-mm visual analogue scales before treatment and 1 month after delivery of their new dentures. Their oral health-related quality of life was determined by completion of an Oral Health-Related Impacts on Quality of Life questionnaire (OHIP-20) at the same time points. RESULTS: Both groups of patients had similar satisfaction and OHIP ratings at the beginning of the study and 1 month after delivery of their new dentures. The two groups were comparable with regard to age and gender. Statistically significant improvement in the OHIP domains of functional limitation and physical and psychological disability was seen in both groups. The conventional group also showed significant improvement with regard to handicap, whereas the duplicate denture group showed significant improvement in the patients' rating of pain and psychological discomfort. Patient satisfaction improved significantly in both groups across all variables except ease of cleaning and ability to speak. The duplication technique resulted in patients being less satisfied with the esthetics of their new dentures. CONCLUSION: In this study, the provision of new dentures either with a conventional technique or with a duplication technique resulted in an overall improvement in oral health-related quality of life and satisfaction. These improvements were statistically significant for some domains, which varied depending on the technique used for construction of the new dentures. Neither technique was seen to be superior, which may be a reflection of the patients' treatment expectations at the outset. Patients' reported satisfaction with their dentures and the impact that dentures have on their quality of life may not be useful measures for determining the most appropriate technique for providing new dentures.

Risk factors for gingival overgrowth in patients medicated with ciclosporin in the absence of calcium channel blockers.

OBJECTIVES: This study investigates the effect of a range of potential risk factors on the severity of gingival overgrowth in transplant patients medicated with ciclosporin in the absence of any calcium channel blockers. MATERIALS AND METHODS: One hundred dentate solid organ transplants medicated with ciclosporin (but not calcium channel blockers or phenytoin) were recruited for the study. Demographic, pharmacological and periodontal data were recorded and gingival overgrowth assessed from stone models. RESULTS: Univariate analysis identified the duration of transplant, papilla bleeding index, creatinine serum concentration, azathioprine and prednisolone dosage as risk factors for overgrowth severity. Multivariate modelling, excluding the periodontal parameters, gave a predictive model that included dosages of ciclosporin, azathioprine, prednisolone and weight (p<0.0001, adjusted-R2=19%). Adding the periodontal variables strengthened the model (p<0.0001, adjusted-R2=34.5%). CONCLUSION: The explanatory models in this study contain a number of variables that moderate inflammation (azathioprine and prednisolone) or are markers of it (papilla bleeding index). Dosage of each of the three immunosuppressants was identified as a risk factor for the severity of gingival change. This observation appears to have been masked by the effects of the calcium channel blockers in earlier studies.

A subjective study of dimensional stability of permanent acrylic resin complete denture bases after a second curing cycle.

The aim of this study was to subjectively assess permanent denture base retention and stability in order to determine whether detrimental change occurred as a result of a second curing cycle. 100 complete upper denture bases were assessed by clinician and patient using visual analogue scales at try-in and insert. No statistically significant alteration in mean scores for retention and stability was seen. 5% of bases showed some deterioration, but none required rebasing or remaking as a result. The advantages of permanent bases during denture construction seem to outweigh the risk of loss of retention and/or stability as a result of distortion due to the second curing cycle.