Ceramic Coatings Confer No Survivorship Advantages in Total Knee Arthroplasty-A Single-Center Series of 1641 Knees.

Background: Ceramic coatings in total knee arthroplasty have been introduced with the aim of reducing wear and consequently improving implant survivorship. We studied both cobalt-chrome-molybdenum (CoCrMo) and ceramic-coated components of the same implant design from a single center to identify if the ceramic coating conferred any benefit. Methods: We identified 1641 Columbus total knee arthroplasties (Aesculap AG, Tüttlingen, Germany) from a prospectively collected arthroplasty database. Of the 1641, 983 were traditional CoCrMo, and 659 had the Columbus AS ceramic coating. Patients were followed up until death or revision of any component of the implant. Results: There was no significant difference in implant survivorship using any component revision as the endpoint between the CoCrMo femur and the ceramic-coated femur at a mean of 9.2 years in follow-up for the CoCrMo group and 5 years for the ceramic-coated group (37 vs 14; P = .76). There was no reduction in the proportion of components revised for aseptic loosening or infection in the ceramic-coated cohort. Conclusions: At midterm follow-up, there was no benefit in terms of implant survivorship in using a ceramic coating.

Factors affecting oral health care for asylum seekers and refugees in England: a qualitative study of key stakeholders' perspectives and experiences.

Aims To investigate factors influencing oral health behaviours and access to dental services for asylum seekers and refugees (ASRs).Methods A qualitative research study using purposeful sampling was undertaken in South West England. Online semi-structured interviews with stakeholders working with or supporting ASRs were analysed through reflexive thematic analysis.Results Twelve participants providing support to ASRs in various capacities participated. Two interviewees had lived experience of forced displacement and the UK asylum process. Key themes into what hinders ASRs' oral health care were: prioritising safety and survival; variations in cultural norms and practice; lack of knowledge about dental care; financial hardship and affordability of care; a gulf of understanding of what dental care would be like and experiences of it; and structures of dental services that leave vulnerable groups behind. Opportunities for improving oral health care were: accessible oral health education; partnership working and creating supportive environments; translation; providing culturally sensitive and person-centred care; and incorporating ASRs' views into service design.Conclusions Several factors affect to what extent ASRs can and are willing to engage with oral health care. Co-developing accessible and relevant prevention programmes and ensuring equitable access to dental services for ASRs is important. Future research should explore ASRs' views and experiences of dental care and explore informed suggestions on how to optimise oral health promotion and provision of care.

What is the global prevalence of dental healthcare needs and unmet dental needs among adolescents?

Data sources Databases searched included Web of Science, PubMed and Scopus.Study selection Cross-sectional studies that estimated dental healthcare needs and unmet dental needs in young people, aged 10-19 years were considered for inclusion. No limitations in terms of year of publication, language, location of the study, gender and race of the participants, or the type of dental health needs and unmet needs were applied. The papers were screened on title and abstract, and then on full text by two reviewers. Any disagreements were resolved through discussion and consultation with a third reviewer.Data extraction and synthesis Data were extracted by three reviewers. Critical appraisal was conducted by two reviewers using the Joanna Briggs Institute critical appraisal checklist. A PRISMA flowchart was used to present the study selection results. Summary measures on the prevalence of dental health needs and unmet needs were calculated. For the meta-analysis, the inverse variance method was used to obtain pooled summary measures.Results Fifty-seven studies were included in the review. The overall prevalence of dental healthcare needs was 49% (95% CI: 42-56) across all types of dental care. The highest prevalence was that for periodontal treatment needs (71%; 95% CI: 46-96 as reported in four studies), followed by that of general treatment needs (59.0%; 95% CI: 42-75 as reported in 12 studies), orthodontic treatment (46%; 95% CI: 38-53 as reported in 32 studies) and lastly that of malocclusion treatment needs (39%; 95% CI: 28-50 as reported in nine studies). The pooled prevalence of unmet dental needs as reported in nine studies was 34% (95% CI: 27-40) with the highest prevalence found in Southeast Asia (72.3%; 95% CI: 70.1-74.5) and the lowest in Europe (11.8%; 95% CI: 3.4-20.3).Conclusions The results of this review showed that the prevalence of dental healthcare needs was higher in America and Europe while unmet needs were more prevalent in Southeast Asia and Africa. The former could partly be explained by the lower number and sample sizes of studies conducted in developing countries.Commentary.

Barriers and facilitators to dental care access among asylum seekers and refugees in highly developed countries: a systematic review.

BACKGROUND: Dental diseases are prevalent among asylum seekers and refugees (ASRs). Despite significant treatment needs, access to dental care in host countries is often limited. The aim of this systematic review was to identify the barriers and enablers to dental care access for ASRs in host countries of very high development. METHODS: Five health and social care databases and eight grey literature sources of information were searched. The Critical Appraisal Skills Programme tool was used to critically appraise included studies. Thematic analysis was undertaken to identify common themes. These were then deductively organised according to Penchansky and Thomas's modified access model. All review stages were conducted by two independent reviewers. RESULTS: Nine papers were included in the review. ASRs encounter significant challenges to accessing dental care in their host countries. These include affordability, communication difficulties, insufficient interpretation, limited knowledge of the healthcare systems and healthcare rights, and negative encounters with healthcare teams. The views and experiences of dental care teams providing care to ASRs were explored in only one study. CONCLUSIONS: Both population and healthcare characteristics influence access to dental care for ASRs. Affordability, awareness and accommodation are most frequently described as barriers to dental access for this population. The diverse needs of this population need to be recognised by policy makers, commissioners and practitioners alike. Cultural competence needs to be incorporated into dental services and any interventions to improve access to dental care for this population. Registration PROSPERO- International prospective register of systematic reviews (CRD42019145570).

Should dental technicians play a greater role in the education of foundation dentists?

In some dental foundation training (DFT) practices, many generations of foundation dentists (FDs) have benefited from being encouraged to build close working relationships with dental technicians. Recent work suggests that new graduates may require additional support with the technical aspects of clinical work due to reduced clinical exposure in undergraduate education. This opinion paper therefore describes how involvement of technical colleagues in the education of FDs could provide important additional feedback on their work and draws upon the concept of 'spiral learning'. It goes on to argue that these opportunities are vital in building mutual respect and the ability to communicate effectively with members of the dental team. Ingraining this approach in FDs is important for their future careers and for the dental profession.

The self-perceived role of sedation-trained dental nurses within a Community Dental Service: a qualitative study.

Background Dental nurses trained in assisting with relative analgesia with nitrous oxide (RA) play an important role in patient care. Provision of RA is a service provided in the Community Dental Service based in Doncaster, Barnsley and Rotherham.Aim To explore how sedation-trained dental nurses perceive their role within a Community Dental Service, and to explore what motivates them and how they feel changes could enhance the provision of care.Methods Twelve nurses who had experience of assisting with RA for at least one year in three community clinics in a South Yorkshire-based Community Dental Service were recruited and undertook a semi-structured interview. All interviews were transcribed verbatim and subsequent thematic analysis of the manuscripts was undertaken.Results Five major themes were identified: 1) motivation; 2) role; 3) training and continuing professional development; 4) pressures on the service; and 5) service enhancements.Conclusion Within this qualitative study, the dental nurses perceived that they had a crucial role in patient and parent behavioural management and keeping the patient safe during treatment. Helping patients to accept planned dental treatment gave them significant job satisfaction. Overall, this study has shown that they feel that they have a crucial role in assisting with RA treatment.

Prophylactic contralateral fixation in slipped upper femoral epiphysis: is it safe?

Prophylactic stabilization with internal fixation of the asymptomatic hip in unilateral slipped upper femoral epiphysis is controversial. We present a retrospective analysis of 65 patients who had prophylactic fixation of the uninvolved hip at the same time as their opposite slipped femoral physis. None had an underlying systemic or endocrine abnormality and the average age was 12.5 years (range 11-15 years). A single 7.0 mm cannulated cancellous screw was used in all patients. The average time to fusion was 18 months (range 6-36 months) and duration of follow up ranged from 5 to 8 years (mean 6.5 years). None of the patients had implant removal and at latest review did not show any evidence of chondrolysis, avascular necrosis, premature physeal arrest or secondary arthrosis in the prophylactically fixed hip. One patient (1.5%) developed a superficial wound infection, which was successfully treated by antibiotics. This study demonstrates the safety of prophylactic fixation using a single cannulated cancellous screw and we recommend it for prevention of delayed slip and hence secondary osteoarthrosis.