Assessing dentists' awareness of the orthodontic-restorative interface.

OBJECTIVES: Awareness of the interface between restorative and orthodontic treatments is essential for dentists to facilitate a meaningful interdisciplinary approach by integrating the knowledge and skills of different dental disciplines into patients' treatment to enhance outcomes. The aim of this study was to investigate General Dental Practitioners' (GDPs) awareness of the orthodontic-restorative interface. METHODS: This was a mixed-method study involving the collection of a) quantitative data via a bespoke online questionnaire and b) qualitative data through open questions. A weblink was created to the questionnaire using Opinio®. The questionnaire was distributed to GDPs practising in the UK. Clinical vignette-based questions assessed GDPs awareness and the results were categorised into two groups: aware and unaware. Two months after the primary survey, respondents were sent an email with follow-up (reliability) survey. Reliability responses were compared against the primary responses to assess the repeatability using intraclass correlation coefficient. Data were analysed using independent t-test and X2 test. RESULTS: 118 complete responses were received. 63 GDPs (53.4 % [95 % CI 44 %-63 %]) demonstrated a good understanding of the orthodontic-restorative interface. These GDPs were characterised by greater age (t = 2.75, p = 0.007) and experience (t = 3.54, p < 0.001). Qualitative data showed that respondents perceived orthodontic-restorative treatments as minimally invasive and aesthetics enhancing. CONCLUSIONS: Orthodontic-restorative treatment aids in minimal invasive dentistry. GDPs lack adequate awareness of the orthodontic-restorative interface in relation to patient care and communication with patients. More quality and structured undergraduate and postgraduate training are imperative to facilitate GDPs to understand and utilise aspects of orthodontic-restorative treatments to raise the standard of patient care. Additionally, to support these patients, the educational pathway between GDPs and specialist orthodontists is crucial. CLINICAL SIGNIFICANCE: GDPs ability to assess and carry out orthodontic-restorative treatments would conserve natural teeth. Dependable access to orthodontic services would encourage GDPs to refer challenging cases to specialists or dentists with enhanced skills. When the circumstances call for it, patients should be given orthodontic-restorative alternatives, regardless of the potential consequences of their acceptance of the procedures.

Longevity of Anterior Composite Restorations for Localized Tooth Wear: A Scoping Review.

(1) Objective: This scoping review evaluates composite restorations as a treatment modality for anterior tooth surface loss and investigates the longevity of the direct and indirect composites used herein. (2) Method: The search encompassed Medline, Embase, Web of Science, the Cochrane Library, and hand search utilizing the PICO framework. (3) Results: Eight studies were included in this review, comprising one randomized controlled trial, one retrospective, and six prospective studies. Some studies reported favorable outcomes for composite restorations in anterior teeth. Although not statistically significant, evidence supported the anterior composite as a viable short- to medium-term solution for managing tooth wear. Direct resin composites were deemed clinically and cost-effective when managing localized anterior tooth wear. However, limitations and inconsistencies in this scoping review limited definitive clinical recommendations. (4) Conclusions: Further research, including well-managed randomized controlled trials using standardized protocols and longer follow-up periods, is essential to reconfirm the long-term efficacies of anterior composite restorations when managing tooth wear. A robust research design and exacting protocols could facilitate more meaningful clinical conclusions.

Dental Teacher Feedback and Student Learning: A Qualitative Study.

INTRODUCTION: Feedback is essential to improve student learning and motivation and to encourage curriculum development by teachers. This study looked at feedback to and from dental students from a qualitative perspective. METHODS: Dental teachers were recruited exclusively to this study from the membership of the Association for Dental Education in Europe (ADEE). Delegates from each of the four annual ADEE conferences were invited to attend focus groups to discuss aspects of feedback. Focus groups established an individual theme for the respective conferences: (i) the role of the teacher in delivering feedback; (ii) feedback from the students' perspective; (iii) changes to feedback due to the COVID-19 pandemic; and (iv) integrating feedback with assessments. RESULTS: Qualitative data collected from the conference delegates were diverse and thought provoking. Delegates reported different styles of feedback varying from individual, personal feedback to no feedback at all. An enforced and mostly positive adaptation to online delivery during the COVID-19 pandemic was reported. A partial return to pre-pandemic practices was described. CONCLUSIONS: Feedback is well recognized by students and teachers as contributing to learning. A universal approach to delivering feedback as part of the student learning process can be challenging due to a multitude of variables. Many aspects of changes in dental education, teaching, and feedback practices adopted as a result of the COVID-19 pandemic have been retained post-pandemic, thereby accelerating the anticipated progression to online teaching.

Students' perceptions of tutor feedback: a pilot study.

BACKGROUND: Feedback offered to dental students by their tutors should aim to elicit ongoing learning and motivation. Previous studies looked at the impact on learning of feedback delivered by tutors from tutors' perspectives. However, what students know about feedback and its purposes and how they experience them during their study effect the impact of feedback on learning. The aim of this pilot study was to assess the proprieties of tutor feedback and its impact on future learning from the students' perspective. METHODS: A short questionnaire based cross sectional survey was designed and delivered electronically to 135 undergraduate and postgraduate students at Brescia Dental School, Italy. The questionnaire consisted of 16 questions which were divided into 3 sections. Quantitative data were collected via Google Forms, the analysis of the data was undertaken using SPSS software, Version 24. RESULTS: Sixty-one students (45.2%) responded to the questionnaire. Forty-one of respondents (67.2%) were undergraduate students and 20 (32.8%) were postgraduate students. The vast majority of students indicated that they received feedback, thirty (49.2%) indicated that it was delivered by tutors and eight (13.1%) by fellow students. Further, students reported that feedback was timely, delivered within two weeks of assessments and that constructive criticism was the favoured feedback style (N.=52, 85.2%). Most students felt that the feedback they received helped with ongoing learning (N.=54, 88.5%). CONCLUSIONS: Most of the respondents considered that feedback received at Brescia Dental school did have a positive impact on their learning. This is of course what tutors hope would be the case but nevertheless it is gratifying to receive this endorsement from the respondent students. A more comprehensive study involving multiple dental schools in different learning environments will now be undertaken, including the collection of qualitative data.

A Scoping Review of Marginal and Internal Fit Accuracy of Lithium Disilicate Restorations.

OBJECTIVE: To assess and compare the accuracy of the marginal and internal fit of lithium disilicate crowns and onlays fabricated by conventional and digital methods. SOURCES: An electronic search was carried out on MEDLINE, Embase, Web of Science and Cochrane Library between 2010 and 2021. STUDY SELECTION: Seventeen studies published between 2014 & 2021 were included, of which thirteen were in vitro laboratory-based studies; three were in vivo clinical studies and one randomised controlled trial. DATA: Twelve studies focused on the marginal fit, five focused on the marginal and internal fit. Five studies found that the marginal and internal fit of crowns were more accurate using digital techniques. Five studies noted that there was no difference using either technique and two noted that conventional methods had a more accurate marginal fit. CONCLUSION: Digital techniques were comparable to conventional methods in terms of accuracy although there was insufficient evidence to indicate that one technique was more accurate than the other with respect to Lithium Disilicate restorations. CLINICAL SIGNIFICANCE: Digital impressions are reliable and viable alternatives for clinicians compared to conventional impression techniques when restoring teeth with lithium disilicate restorations.

Wealth Management and Retirement.

SUMMARY: The purpose of this publication is to introduce basic financial planning concepts and highlight their use in creating a retirement savings plan. These tools may help young surgeons set their financial targets and create a plan to meet them, whereas surgeons later in their careers may reflect on their choices and implement adjustments, or be inspired to pass on the lessons they learned to the next generation. This publication is limited by design and should be thought of as a primer, not a comprehensive treatise. The topic of personal financial management is as vague as it is broad, and there are many concepts and situations that are outside the scope of this publication. Unique goals, income and expense streams, and risk tolerances necessitate individualized solutions, but there are fundamental concepts listed below that are more universally applicable. The discussion is tailored to the high income stream that plastic surgeons can expect, albeit one that starts relatively late in their careers compared to nonphysician colleagues. There are three foundational principles the reader should take away: having a plan is crucial in achieving any financial goal; starting any savings/investment endeavors as early as possible is as or more important than the amount of capital committed to them; and lastly, individual investors (professional and amateur) have consistently demonstrated an inability to consistently do better than the market over the long run.

An investigation into the management of the deep carious lesion by general dental practitioners in the UK.

Objectives As techniques and dental materials have evolved, the management of deep carious lesions has also changed. This study investigated how UK-based general dental practitioners (GDPs) managed deep carious lesions in permanent, vital teeth and factors that influence their choices.Methods This mixed-method study employed an online questionnaire as its primary source of quantitative data collection. The questionnaire enquired about GDPs': a) demographics; b) working environment; and c) whether they had postgraduate training that covered caries management/minimally invasive dentistry (MID). Respondents were presented with a clinical case to elicit qualitative data. Relevant questions were asked in order to examine current practice and explore treatment among the respondents.Results In total, 239 responses were received. Overall, 168 (70% [95% CI 64%, 76%]) of the respondents chose a partial caries removal technique, 155 (69.3% [95% CI 60%, 72%]) used an adhesive restorative material and 205 (85.8% [95% CI 81%, 89%]) advised fluoride adjuncts. However, rubber dam (75; 31.4% [95% CI 26%, 38%]) and saliva testing (17; 7.1% [95% CI 4%, 11%]) were not routinely used. A significant relationship between those who had postgraduate training and those who chose partial caries removal as their treatment choice (χ2 = 6.27; p = 0.01) was noted. Respondents working in an NHS-based practice were significantly (χ2 = 34.98; p <0.001) more likely to restore teeth with amalgam.Conclusions There is an inconsistent management protocol when presented with a deep carious lesion, but partial caries removal is more widely adopted than previously reported. Rubber dam isolation was not routinely used when choosing to restore a deep carious lesion. Those who have had postgraduate training felt more confident in offering MID, so there is a clear need for further education to ensure its engagement.

Developing the role of the sports dentist.

Sports dentistry has traditionally focused on orofacial trauma. There is now increasing evidence that participation in sport, particularly at elite level, may significantly increase the risks to oral health. The negative impact of poor oral health on athlete-reported wellbeing and performance is clear. The risks to athlete oral health can and should be mitigated and the role of the sports dentist is evolving to meet these new challenges. Custom-made mouthguards provide protection against orofacial trauma and potentially, concussion. Oral health screening should be included in athlete pre-season preparation. As integrated members of the athlete support team, dentists and dental care professionals can provide sport-specific oral health advice, encouraging athletes to take ownership of their oral health. The potential for translational health and wellbeing benefits to the wider population is also substantial, particularly with youth groups and recreational athletes. Sports dentistry requires distinctive skills. A UK-wide network of dentists and other oral health professionals with an interest in sport is important, to ensure that both appropriate advice and treatment is evidence-based and to further develop the research and clinical foundations.

General dental practitioners' knowledge and opinions of snoring and sleep-related breathing disorders.

Aims There is increasing recognition that sleep disturbances can affect lifestyle, economy and health. General dental practitioners (GDPs) can play a vital role in helping to identify at-risk patients through screening as well as aid in the management of these conditions. The aim of this study was to assess the knowledge of UK-based GDPs in relation to sleep-related breathing disorders (SRBDs).Material and methods A questionnaire was developed to assess GDPs' knowledge of SRBDs and their current practice in relation to the management of SRBDs, and identify the factors associated with improved knowledge and management. A volunteer sample was recruited from social media platforms and conference attendees.Results In total, 152 GDPs completed the questionnaire; 101 (66% [95% CI 59%,74%]) agreed that GDPs should ask their patients about sleep disorders, while only 82 (54% [95% CI 46%,62%]) confirmed that they actually asked their patients about the problem. On a 22-point knowledge scale, the mean score was 12.93 (95%CI 12.23, 13.63). Postgraduate education (F = 5.47; p = 0.001), increasing age (r = 0.23; p = 0.005) and GDP workplace (F = 4.98; p = 0.008) contributed to a higher knowledge score. GDPs were strongly in favour of having more information (N = 141; 93% [95% CI 87%,97%]).Conclusion Although GDPs' knowledge of SRBDs was better than anticipated, they clearly felt a need for further information and training. There is a compelling case to include this subject in the undergraduate dental curriculum.

Investigating the effect of mouth guard use on aerobic performance in amateur boxers.

OBJECTIVES: To assess if wearing a mouth guard impacts maximal aerobic capacity in amateur boxers. MATERIALS AND METHODS: A prospective crossover cohort (pilot) study was conducted to assess maximal aerobic capacity in amateur boxers using the 20 m multi stage fitness test (MSFT). Two primary outcomes measures were recorded: (1) the maximum oxygen uptake (peak VO2 -mL/kg/min) and (2) distance run (meters-m). Thirteen amateur boxers completed the MSFT 7 days apart under control (no mouth guard-C) and intervention conditions (mouth guard-MG). Participants also submitted data on height, weight, type of mouth guard and Rate of Perceived Exertion (RPE) during the test. STATISTICS: Paired T-test. RESULTS: Mouth guard use was shown to reduce peak VO2 and distance run during the 20 m MSFT from 56.31 to 54.12 mL/kg/min and 2572 to 2380 m respectively (p < 0.05). Twelve out of 13 participants wore a Boil & Bite mouthguard and recorded lower peak VO2 scores (-4.38%) when wearing a mouth guard compared to control conditions, (Mean = -2.46 mL/kg/min, Range of decrease = 4.2-0.9 mL/kg/min; p < 0.05). Ten participants submitted data on RPE-One participant with a custom made mouthguard reported no change in RPE in mouthguard conditions, while nine participants reported an average (+30.5%) increase in mean RPE in Boil & Bite mouthguard conditions compared to control conditions. CONCLUSIONS: Boil & Bite mouth guard use was shown to significantly reduce aerobic performance in amateur boxers and increase the perceived rate of exertion during the 20 m MSFT.

Implementing a New Service Line Model to Support Growth and Serve Patients.

SUMMARY: Many healthcare organizations are reinvesting in clinical service lines to differentiate themselves, standardize evidence-based care, and add value. Typically, service line structures are built around hospital-based procedures and are accountable solely to local operations. That can be a blueprint for missed growth and lost value.Banner Health, based in Phoenix, Arizona, with operations in six southwestern states, has pivoted to a systemwide service line strategy to foster growth and support value-based care. Service lines are now organized to maximize both revenue and quality across the continuum of care, to the benefit of both the system and its patients. The new, team-based structure allows Banner Health to respond nimbly to changes in the healthcare environment because it is based on the ways patients access the system. In 2021, just two years into this complex transition, the results have demonstrated that this service line model can achieve measurable benefits that include growth; improved financial performance, safety, and clinical outcomes; and increased collaboration in value-based payment models-all helping the system to realize its mission of making healthcare easier so that life can be better for our patients.

'Injury prevention versus performance': has the time come to mandate the use of mouthguards in all contact sports?

Mouthguard use continues to be a hotly debated issue in the domain of contact sports. Regulations from sports governing bodies on wearing mouthguards and attitudes towards their use from athletes vary significantly across 'at-risk sports'. We explore how recent advances in sports dentistry have led to the widespread availability of new customisable mouthguards and whether their use may impact athletic performance, reduce orofacial trauma or sport related concussion. We also discuss whether 'no mouthguard, no play' policies designed to mandate their use may help to promote a culture of safe participation in contact sport.

Teacher feedback and student learning: A quantitative study.

INTRODUCTION: Feedback plays a significant role in informing students about the outcome of their assessments and contributes to their ongoing learning. The aim of this study was to investigate feedback currently given by clinical teachers to dental students throughout Europe. METHODS: This study used a piloted questionnaire, delivered on-line to members of the Association for Dental Education in Europe (ADEE). A largely quantitative approach was adopted with multiple-choice, single answer, open text boxes and Likert scale type questions. These data were collected via Google Forms, transferred to an excel spreadsheet and analysed using SPSS software Version 24. RESULTS: Data were collected from 223 questionnaires completed by respondents from 42 countries. Students received feedback following: (i) formative assessment (70%; n = 155), (ii) summative assessment (88%; n = 196) and iii) informally at any time (85%; n = 188). Feedback was delivered by different people including administrative staff (15%; n = 25). Several methods were used to deliver feedback, including written, oral/spoken, email and individually or as a group. 85% (n = 184) of teachers reported that their teaching had changed following feedback they had received from students. CONCLUSION: The study showed a strong ethos of delivering feedback from teachers to dental students following both assessment and non-assessment related activities. Teachers should understand/appreciate the individualistic nature of feedback and the importance of cultivating a congenial environment for feedback delivery. Challenges remain in delivering them to a high standard and in a timely manner.

Effects of the lower jaw position on athletic performance of elite athletes.

When an athlete wears a mouthguard, the position of the lower jaw is changed by virtue of the teeth being unable to occlude. Little research is available in in this area, which have indicated both positive impact and no positive impact. OBJECTIVES: This study aims to explore the influence of the lower jaw position on athletic performance in elite athletes. METHODS: A repeated measures study compared two lower jaw positions, the athlete's normal (habitual) bite and the lower jaw position when the muscles of mastication are at physiological rest (physiological rest bite). 15 athletes completed a medicine ball putt (upper body power), vertical jump (lower body power), sit and reach (composite hamstring flexibility), passive knee flexion (hamstring muscle length) and star excursion balance (stability and balance) tests in each condition. RESULTS: Paired t-tests showed the physiological rest bite had significant (p<0.05) positive effect on athletic performance for each test. On average the physiological rest bite provided an increase of lower body power (5.8%), upper body power (10%), hamstring flexibility (14%) and balance and stability (4.8%) compared to the habitual bite. CONCLUSION: This study provides evidence of the need for further research to confirm if the lower jaw position can be optimised for athletic performance in athletes.

The teaching of occlusion in undergraduate dental schools in the UK and Ireland.

Aim This study investigated and evaluated the teaching of occlusion in undergraduate dental schools in the UK and Ireland, the thorough understanding of which would facilitate young graduates to become competent practitioners.Material and methods A mixed-methods approach was employed, with primary data generated and collected by using a cross-sectional, questionnaire-based survey which was followed-up by semi-structured interviews. The hard copy questionnaires enquired about: i) whether occlusion was taught; ii) how long was spent by schools teaching occlusion; iii) what teaching resources were employed; iv) tutors' perceptions of how well prepared for general practice new graduates were; and v) how was knowledge/skill assessed. Follow-up interviews were undertaken with volunteering respondents to triangulate responses. Quantitative data were analysed using descriptive statistics and qualitative data were stored using the Framework Method and analysis using a thematic approach.Results One hundred percent (n = 18) of schools responded to the questionnaire and 66.67% (n = 12) of the schools participated in follow-up interviews. All schools reported that they taught occlusion in their curriculum. Total hours reported teaching occlusion varied from 11 to 310 hours. Twenty-eight percent (n = 5) of respondents reported insufficient time for the teaching of occlusion in the curriculum. There was a marked variation in: i) teaching methods; ii) resources employed; iii) assessment strategies to evaluate competency in occlusion; and iv) how well prepared students were. Thematic analysis of the qualitative data identified several themes: i) variations in teaching pedagogy; ii) use of different resources; iii) variable assessment techniques; iv) evaluation of teaching; and v) barriers to teaching occlusion.Conclusion Recommendations for a coordinated teaching strategy with dedicated oversight to facilitate better student exposure to occlusion and promote student understanding of this topic is suggested.

Oral health behaviors, dental injuries and mouthguard awareness among a sample of portuguese athletes: a cross sectional study / Comportamientos de salud bucal, lesiones dentales y conciencia del uso de protectores bucales entre una muestra de atletas portugueses: estudio transversal

Aim: To determine the oral health behaviors, the prevalence of dental injuries, the level of information about first-aid procedures in the case of dental avulsion and the mouthguard awareness in a sample of Portuguese athletes. Materials and Methods: Cross-sectional researchamong 1,048 athletes from the district of Viseu, Portugal. A self-administered questionnaire included demographic data and questions about: I) oral hygiene habits, II) occurrence of orofacial trauma, III) use of mouthguards and IV) athletes' knowledge regarding first-aid management in case of dental avulsion was given. The comparison between different variables was made by Chi-square test with level of significant set at p-value ≤0.05. Results: The mean age of the sample (76.24% male) was 18.14±8.17 years. Overall, the results demonstrated a low use of dental floss (25.48%) and a high number of athletes (21.94%) that had not visited a dentist in more than a year. The prevalence of dental trauma was 5.06% and the most common dental injuries experienced by athletes were crown fractures (60.38%). Nearly half of the participants (45.23%) reported not knowing how to act following a dental avulsion. The rate of mouthguard use was very low (9.73%). There was a significant relationship between the prevalence of dental injuries and the use of mouthguards (p=0.000; Cramér's V=0.145). Conclusion: The prevalence of dental trauma in our population was low. A low number of athletes use a mouthguard and there is a lack of knowledge concerning dental trauma issues. Prevention programs and promoting actions among this population are important and should be adopted.

Objetivo: Determinar los comportamientos de salud bucal, la prevalencia delesiones dentales, el nivel de información sobre los procedimientos de primeros auxilios en el caso de la avulsión dental y el conocimiento de los protectores bucales en una muestra de atletas portugueses. Materiales y métodos: estudio transversal de 1048 atletas del distrito de Viseu, Portugal. Se utilizó un cuestionario auto administrado que incluyó datos demográficos y preguntas sobre: I) hábitos de higiene bucal, II) ocurrencia de traumatismos orofaciales, III) uso de protectores bucales y IV) conocimiento de los atletas sobre el manejo de primeros auxilios en caso de avulsión dental. La comparación entre diferentes variables se realizó mediante la prueba de chi-cuadrado con el nivel de significancia establecido en p≤0.05. Resultados: La edad promedia de la muestra (76,24% hombres) fue de 18,14±8,17 años. En general, los resultados demostraron un bajo uso de hilo dental (25,48%) y un alto número de atletas (21,94%) que no habían visitado un dentista en más de un año. La prevalencia de trauma dental fue de 5,06% y las lesiones dentales más comunes que experimentaron los atletas fueron las fracturas de corona (60,38%). Casi la mitad de los participantes (45,23%) informaron que no sabían cómo actuar después de una avulsión dental. La tasa de uso de protectores bucales fue muy baja (9,73%). Hubo una relación significativa entre la prevalencia de lesiones dentales y el uso de protectores bucales (p=0,000; V de Cramer=0,145). Conclusión: la prevalencia de trauma dental en nuestra población fue baja. Un número bajo de atletas usa un protector bucal y hay una falta de conocimiento sobre temas de trauma dental. Programas de prevención y acciones de promoción entre esta población son importantes y deben ser adoptados.

The impact of confidence on clinical dental practice.

INTRODUCTION: Increasing confidence through learning has the potential to change General Dental Practitioners' (GDPs) perceptions of clinical practice. By examining how changes in confidence influence the clinical practice of two cohorts of GDPs, during and following an extended period of postgraduate training, we show the importance of confidence to GDPs and that a lack of confidence is a primary reason why GDPs attend postgraduate training courses. METHODS: A mixed-method approach was adopted for this study. Quantitative data were collected via a series of linked questionnaires; qualitative data were collected using focus group discussions, interviews and contemporaneous field notes. Analysis was undertaken using SPSS software and a phenomenological approach, respectively. FINDINGS: Participants indicated an increase in confidence in their ability to undertake dental procedures, which led to an increase in confidence in communication skills, and their ability to undertake complex restorative procedures. This led to greater treatment acceptance by patients resulting in better "job satisfaction." DISCUSSION: A sense of confidence is central to personal development and ongoing study, leading to first, an improved capability to perform tasks (competence); second, confidence is a product of the relationship and trust of those people associated with the individual/professional and third, the correct level of challenge is important to confidence. CONCLUSIONS: The issue of confidence has not been looked at in postgraduate dentistry, but it is well recognised in medical education fields.