A Service Evaluation of Dental Assessments Prior to Treatment for Head and Neck Cancer in NHS Grampian.

To minimise the risk of Osteoradionecrosis (ORN) following radiotherapy, dental assessments are carried out by Restorative Consultants to determine teeth of poor prognosis requiring extraction before the commencement of radiotherapy for oncological treatment. Social deprivation is a high-risk factor for poor oral health and head and neck cancer (HANC), consequently highlighting the importance of the prehabilitation pathway, including dental assessment. AIM: To retrospectively assess the demographics of the HAN oncology patient cohort, treatment modality, prehabilitation pathway and timeframe within NHS Grampian and highlight the role of the Restorative Dental Consultant. MATERIALS AND METHODS: Retrospective assessment of 120 HANC patients' clinical records from May 2018 to December 2019. The patients were selected as a continuous cohort from Restorative Consultant dental assessment clinics. RESULTS: Radiotherapy was the most common treatment modality, with 91% of patients receiving treatment; the mean time between completing dental extractions and commencing radiotherapy for oncological treatment was 17.98 days. CONCLUSION: The HANC prehabilitation pathway should be conducted in a timeframe that allows patients to have sufficient time for healing between extractions and oncological treatment commencing to reduce ORN risk. The study also demonstrates an increased incidence of HANC in areas of higher social deprivation.

Zirconia implants: a promising alternative to titanium?

Design This study is a monocentre cohort study with a primary aim to assess the five-year survival of alumina-toughened zirconia (ATZ) implants (Metoxit AG, Thayngen, Switzerland). Secondary aims were to evaluate peri-implant marginal bone loss (MBL), soft tissue health and patient-reported outcome measures (PROMs). The implants were placed into healed ridges and, following a period of temporisation, were restored with either IPS e.max CAD LT or IPS e.max ZirCAD veneered with IPS e.max ZirPress (Ivoclar Vivadent, Schaan, Liechtenstein). Patients were followed up at prosthetic delivery, one-year and five-years post-implant placement. The clinical parameters recorded were clinical attachment levels (CAL), probing depth (PD), gingival recession (GR), modified bleeding index (mBI) and modified plaque index (mPI). MBL was evaluated using standardised radiographs. PROMs were used to assess patients' satisfaction utilising a visual analogue scale (VAS) to rate function, aesthetics, sense, speech and self-esteem. The null hypothesis assumed there was no difference in implant survival between one and five years post-operatively. This study was approved by the ethics committee at the University of Freigburg, Germany (No. 354/07).Cohort selection Forty patients from the Department of Prosthetic Dentistry requiring either an implant supported single crown or a three-unit implant-supported bridge were included in the study. Patients ranged from age 18 to 70 and were selected on a 'convenience basis'. Inclusion criteria stipulated patients must have good oral hygiene, compliance and be systemically healthy. Additionally, they were to have a stable occlusion, no signs of significant bruxism and sufficient bone volume to allow implant placement without the need for larger augmentative procedures.Data analysis Implant success was defined by three main criteria: (1) no local or systemic reactions; (2) no signs of radiolucency on an intraoral radiograph; and (3) provides support to a functional restoration. The MBL was classified as successful when at a one-year follow-up, implants demonstrating no clinical or radiographic signs of pathology are assigned a grade I success with <2 mm of MBL or grade II with <3 mm of MBL. Data analysis was performed by a single independent member of the university using 'xtmixed' on the software STATA 16.1 (StataCorp LT, College Station, TX, USA). This utilised linear mixed models with random intercepts to assess the impact of time, the type of restoration (single crown or bridge) and the location of the implant (either being adjacent to a natural tooth or an implant) on the peri-implant soft tissues, bone and PROMs. The Scheffé test was utilised to allow multiple pairwise comparisons and the level of significance was set at 0.05.Results Of the 40 patients, 27 received a single implant for restoration with an implant crown and 13 patients received two implants for restoration with a three-unit bridge. This totalled 53 implant placements, 18 in the maxilla and 35 in the mandible. Three of the 27 patients who received a single implant experienced early failure, before definitive restoration. Of the 37 patients who had their implants restored, two patients each with a single implant were lost to follow-up between one and five years, one deceased and one relocated. The five-year survival was 94.3% with all failures occurring before definitive restoration. The null hypothesis could not be rejected, with the study demonstrating no difference in ATZ implant survival rates between the one- and five-year follow-up. An MBL of 0.71 mm was seen from implant placement to definitive restoration, a statistically significant difference (p <0.001). The MBL at one- and five-year follow-up demonstrated no significant difference, with 0.78 mm and 0.81 mm of MBL, respectively. Greater MBL was found with the three-unit implant bridges compared to the single implant crowns and no other factors were found to be significant. Regarding the peri-implant soft tissues between prosthetic delivery and five-year follow-up, there was a significant increase in the PD, mPI and mBI (p <0.001) but no significant difference in the CAL and GR. Although the mPI increased, they assure us the oral hygiene of the patients was still 'regarded as good' and the increase may be attributable to the crown design. All PROMs showed a significant average improvement from baseline to definitive restoration and over the course of the five-year follow-up, patients' perceptions of aesthetics and sense increased further.Conclusions ATZ implants placed in this select cohort of patients show good performance over a five-year follow-up with respect to survival, MBL, soft tissue health and PROMs.

Operator's ability at assessing a high-speed (air turbine) handpiece before use: an audit.

BACKGROUND: The 'high-speed' (air turbine) handpiece is used extensively across many dental disciplines and the ability of clinicians to detect faulty handpieces is essential. AIM: The primary aim of this audit was to determine the proportion of participants who could correctly identify unsafe handpieces. Secondary aims were to determine the proportion that had previous training on the topic and determine whether an educational video could improve scores. METHOD: Eighty participants completed the first round of audit. They were asked to inspect seven handpieces, five of which were faulty, with three being classed as unsafe. After the intervention (educational sessions and distribution of a video) a second round of audit was completed on 69 participants. RESULTS: The ability to detect the three unsafe handpieces increased from 10% to 44% over the two rounds of audit. In the second round the highest score obtained was by those who had received the intervention, 77%. The lowest score, 14%, was by those who had not received the intervention. Nine percent of participants in the first round stated they had previously had training on handpiece inspection and none of these participants identified the three unsafe handpieces. CONCLUSION: This audit has highlighted that there is a knowledge deficiency with regards to air turbine handpiece safety and inspection. We have shown that introduction of a simple education video can have an impact on dentists and students abilities to detect unsafe faults. We have already introduced this into the undergraduate curriculum in our school and we aim to also raise awareness within the dental community.

Sectioning of a double tooth aided by cone-beam computed tomography.

BACKGROUND: Double teeth present challenges for their clinical management. Recent advances in imaging, particularly cone-beam computed tomography (CBCT), have aided clinicians in accurate diagnosis and management. Data from CBCT imaging can be used for three-dimensional reconstruction to further aid pre-surgical planning. CASE REPORT: A 14-year-old Caucasian male presented with an aesthetically unacceptable double tooth in the 22 region. Clinical and radiographic examination and assessment included CBCT imaging and three-dimensional reconstruction. TREATMENT: Based on this information, together with a comprehensive assessment of the patient's motivation, a treatment plan consisting of extra-alveolar sectioning, re-implantation, endodontic therapy and composite resin restoration was carried out. FOLLOW-UP: The patient failed to return for follow-up at 6 months post-treatment. However, he did return at 12 months, where clinical and radiographic examination was undertaken. At this point the tooth was clinically sound and bony infill was seen radiographically. CONCLUSION: The information gained from the pre-surgical imaging with CBCT was useful in planning treatment in this case. However, this had to be combined with a careful assessment of the patient's motivation to ensure that the course of treatment embarked upon was likely to be successful whilst addressing the patient's concerns.

Cross-species amplification of soybean (Glycine max) simple sequence repeats (SSRs) within the genus and other legume genera: implications for the transferability of SSRs in plants.

We investigated the transferability of 31 soybean (Glycine max) simple sequence repeat (SSR) loci to wild congeners and to other legume genera. Up to 65% of the soybean primer pairs amplified SSRs within Glycine, but frequently, the SSRs were short and interrupted compared with those of soybeans. Nevertheless, 85% of the loci were polymorphic within G. clandestina. Cross-species amplification outside of the genus was much lower (3%-13%), with polymorphism restricted to one primer pair, AG81. AG81 amplified loci in Glycine, Kennedia, and Vigna (Phaseoleae), Vicia (Vicieae), Trifolium (Trifolieae), and Lupinus (Genisteae) within the Papilionoideae, and in Albizia within the Mimosoideae. The primer conservation at AG81 may be explained by its apparent proximity to the seryl-tRNA synthetase gene. Interspecific differences in allele size at AG81 loci reflected repeat length variation within the SSR region and indels in the flanking region. Alleles of identical size with different underlying sequences (size homoplasy) were observed. Our findings and the emerging patterns in other plant studies suggest that in contrast to animals, successful cross-species amplification of SSRs in plants is largely restricted to congeners or closely related genera. Because mutations in both the SSR region and the flanking region contribute to variation in allele size among species, knowledge of DNA sequence is essential before SSR loci can be meaningfully used to address applied and evolutionary questions.

Local dental anaesthesia and evidential breath testing: the effect of injection of local anaesthetic on lip seal.

The effect of local anaesthetic infiltration on the ability of subjects to provide adequate specimens of breath for analysis using an evidential breath testing device was assessed. The results showed that in ten out of the fourteen cases there was no impairment of the ability to provide the specimens of breath at any time. Within two hours of the administration of a local anaesthetic all subjects were able to provide the requisite samples.

Saccade-related and visual activities in the pulvinar nuclei of the behaving rhesus monkey.

We studied three subdivisions of the pulvinar: a retinotopically organized inferior area (PI), a retinotopically mapped region of the lateral pulvinar (PL), and a separate, visually responsive component of the lateral pulvinar (Pdm). Single neurons were recorded in these regions from awake, trained rhesus monkeys, and we correlated the discharge patterns of the cells with eye movements. About 60% of the neurons discharged after saccadic eye movements in an illuminated environment and had either excitatory, inhibitory, or biphasic (inhibitory-excitatory) response patterns. These responses were most often transient in nature. Neurons with excitatory activity had a mean onset latency of 72 ms after the termination of the eye movement. Latencies for cells with inhibitory responses averaged 58 ms. In sharp contrast, the cells with biphasic response patterns became active before the termination of the eye movement. A unique set of these neurons termed saccade cells, were active with visually guided eye movements in the light, with the same eye movements made to a briefly pulsed target in the dark, and for similar eye movements made spontaneously in total darkness. The activity was present with the appropriate saccade, independent of the beginning eye position. Biphasic response patterns were typical of these saccade cells. Saccade cells were most common in Pdm and PI. About half of the saccade cells also had some visual response that was independent of eye movement. A second group of cells was active with saccadic eye movements in the light but not in the dark. Some of these cells had clear visual responses that could account for their activity following eye movements; others had no clear visual receptive field.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulvinar nuclei of the behaving rhesus monkey: visual responses and their modulation.

We have examined the properties of neurons in three subdivisions of the pulvinar of alert, trained rhesus monkeys 1) an inferior, retinotopically mapped area (PI), 2) a lateral, retinotopically organized region (PL), and 3) a dorsomedial visual portion of the lateral pulvinar (Pdm), which has a crude retinotopic organization. We tested the neurons for visual responses to stationary and moving stimuli and for changes in these responses produced by behavioral manipulations. All areas contain cells sensitive to stimulus orientation as well as neurons selective for the direction of stimulus movement; however, the majority of cells in all three regions are either broadly tuned or nonselective for these attributes. Nearly all cells respond to stimulus onset, a significant number also give a response to stimulus termination, and rarely a cell gives only off responses. Nearly all cells increase their discharge rate to visual stimuli. Receptive fields in the two retinotopically mapped regions, PI and PL, have well-defined borders. The sizes of these receptive fields show a positive correlation with the eccentricity of the receptive fields. The receptive fields in the remaining region, Pdm, are frequently very large, but with these large fields excluded, show a similar correlation with eccentricity. All pulvinar cells tested (n = 20) were mapped in retinal coordinates; the receptive fields are positioned in relation to the retina. We found no cells with gaze-gated characteristics (2), nor cells mapped in a spatial coordinate system. The response latencies in PI and PL are shorter and less variable than the latencies in Pdm. Active use of a stimulus can produce an enhancement or attenuation of the visual response. Eye-movement modulation was found in all three subdivisions in about equal frequencies. Attentional modulation was common in Pdm and was rare in PI and PL. The modulation is spatially selective in Pdm and nonselective in PI for a small number of tested cells. These data demonstrate functional differences between Pdm and the other two areas and suggest that Pdm plays a role in selective visual attention, whereas PI and PL probably contribute to other aspects of visual perception.

Behavioral analyses of visual cortex of the Galago.

For the purpose of examining some of the principles underlying the function of primate visual cortex, the performance of one normal control group and three operated groups of Galagos having bilateral cortical lesions in area 17 (S), the middle temporal area (MT), or areas 18 and 19 (XS) was assessed on tasks measuring visual sensory capacity, search, and learning. Striate lesions produced a reduction in foveal vision and were responsible for deficits only on a complex visual learning task. The lesions of Group MT extended beyond area MT and involved the optic radiations. This resulted in impairments on all visual problems. Animals in Group XS had subtotal lesions of prestriate cortex and were also impaired on each task, but they showed less severe deficits in sensory capacity than animals in Group MT. It is suggested that the Galago's striate cortex plays a major role in the identification and utilization of relevant visual information and that areas 18 and 19 are important in both visual learning and visuospatial analyses. Evidence is provided that area MT is involved in visual search.

Personality correlates in a sample of male nurses in the British Royal Air Force.

This descriptive study provides data relevant to two currently popular views of the male nursing image. Firstly, that male nurses tend to prefer the more technological or administrative aspects of nursing and secondly, that they exhibit to an unusually high degree what are commonly thought of as being amongst the more feminine personality traits. The sample consisted of 91 male RAF nurses working in RAF hospitals, and was of predominantly English nationality. Of the 39 SRNs in the sample 65.8% preferred general nursing to the more technical areas such as intensive care, operating theatre, orthopaedic and renal. The preference for general nursing was even greater, 76.1%, amongst the 30 SENs surveyed. The Eysenck Personality Questionnaire (EPQ) and a Level of Aspiration Test (LOA) were used to obtain measures of the personality traits of the sample. The scores obtained showed that the male RAF nurses were significantly less psychotic than male civilian nurses, male civilians or serviceman of similar age. They were also significantly less extraverted than servicemen as a whole and significantly more stable than the male civilian norm. A comparison of SRNs with SENs revealed only two significant differences. The SRNs were significantly less extraverted and had a significantly higher level of adpiration than the SENs.

Middle temporal cortical visual area and visuospatial function in Galago senegalensis.

Bushbabies with lesions restricted to the middle temporal (MT) area and animals with larger extrastriate lesions including area MT were compared with normal control animals on test of visuospatial localization and discrimination learning. Ablation of area MT was sufficient to produce impairments in directing behavior appropriately on the basis of visuospatial cues. Extension of the lesion into areas 18 and 19 produced more profound deficits. Retardation in learning a stripe discrimination problem was correlated with the extent of damage to the geniculostriate system. It is hypothesized that area MT is important in achieving and maintaining fixation on a target whereas cortical areas 18 and 19 are necessary for establishing the location of stimulation in visual space.