The impact of the COVID-19 pandemic on 397 631 elective dental admissions among the under-25s in England: a retrospective study.

BACKGROUND: COVID-19 caused widespread disruptions to health services worldwide, including reductions in elective surgery. Tooth extractions are among the most common reasons for elective surgery among children and young people (CYP). It is unclear how COVID-19 affected elective dental surgeries in hospitals over multiple pandemic waves at a national level. METHODS: Elective dental tooth extraction admissions were selected using Hospital Episode Statistics. Admission trends for the first 14 pandemic months were compared with the previous five years and results were stratified by age (under-11s, 11-16s, 17-24s). RESULTS: The most socioeconomically deprived CYP comprised the largest proportion of elective dental tooth extraction admissions. In April 2020, admissions dropped by >95%. In absolute terms, the biggest reduction was in April (11-16s: -1339 admissions, 95% CI -1411 to -1267; 17-24s: -1600, -1678 to -1521) and May 2020 (under-11s: -2857, -2962 to -2752). Admissions differed by socioeconomic deprivation for the under-11s (P < 0.0001), driven by fewer admissions than expected by the most deprived and more by the most affluent during the pandemic. CONCLUSION: Elective tooth extractions dropped most in April 2020, remaining below pre-pandemic levels throughout the study. Despite being the most likely to be admitted, the most deprived under-11s had the largest reductions in admissions relative to other groups.

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England.

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

A multi-site service evaluation of silver diamine fluoride use for children.

Introduction The use of silver diamine fluoride (SDF) is relatively new to the UK. It is unknown how it is being used and for what indications in UK paediatric dental services.Aim To: 1) establish how SDF is being used across different paediatric dental settings in the UK; and 2) consider parental and patient views on the treatment experience and side effect of discolouration.Method A multi-site service evaluation was carried out across six paediatric dentistry units covering hospital and community services. Data were collected prospectively from 17/02/2020 to 02/03/2022. Simple descriptive statistics were used to analyse the data.Results Data were collected for 54 patients. The included patients had an age range of 2-13 years, with a mean of 4.9 years. The reason SDF was chosen was reported as: to avoid general anaesthetic (n = 25); to avoid extractions (n = 8); stabilisation (n = 25); acclimatisation (n = 24); and insufficient cooperation for other treatment (n = 17). In total, 42 cases had SDF applied to the primary dentition. This was in the anterior dentition for 18 patients and the posterior dentition for 15, with nine patients having SDF applied both anteriorly and posteriorly. The majority of children and parents were accepting of the technique and immediate aesthetic outcome.Conclusion In the services involved in this multi-site service evaluation, SDF is used for young patients in the primary dentition for the purpose of caries arrest. The technique was viewed positively by the majority of parents and children.

The effect of varying monocalcium phosphate and polylysine levels on dental composite properties.

OBJECTIVES: The aim was to quantify effects of polylysine (PLS, 2 or 5 wt%) and monocalcium phosphate (MCP, 4 or 8 wt%) on properties of dental composites. METHODS: Light-activated, lower surface polymerisation kinetics versus sample depth (1-4 mm) of 4 formulations were quantified using ATR-FTIR. Water sorption and solubility (at 1 week) were assessed following ISO/4049. PLS release (over 1 month) and biaxial flexural strength (over 6 months) of fully-cured, water-immersed, 1 mm thick discs were determined. Surface mineral precipitation, following immersion in simulated body fluid (SBF), was assessed by SEM. Z250 was used as a conventional composite comparator. RESULTS: With 40s light exposure, increasing depth (from 1 to 4 mm) led to enhanced delay before polymerisation (from 3 to 17s) and decreased final conversion (72-66%) irrespective of PLS and MCP level. Increasing PLS and MCP raised solubility (4-13 µg/mm3). Water sorption (between 32 and 55 µg/mm3) and final PLS release (8-13% of disc content) were raised primarily by increasing PLS. Higher PLS also reduced strength. Strength reached minimum values (69-94 MPa) at 3 months. Surface mineral deposition was enhanced by increased MCP. For Z250, polymerisation delays (3-6s) and final conversions (55-54%) at 1-4 mm depth, solubility (0 µg/mm3), water sorption (16 µg/mm3) and strength (180 MPa) were all significantly different. CONCLUSION: Delay time increased whilst final conversion decreased with thicker samples. Higher PLS enhances its percentage release, but lower level is required to keep water sorption, solubility and mechanical properties within ISO 4049 recommendations. Doubling MCP raises solubility and enhances minerals reprecipitation with minimal mechanical property compromise.

Multidisciplinary management of missing maxillary central incisors in children and adolescents.

Missing maxillary central incisors can impact a patient's psychological wellbeing and smile aesthetics. Comprehensive management of such cases requires a multidisciplinary team approach, often involving orthodontic, paediatric and restorative dental teams. This paper summarises the various management options for these complex patients.

Limited Effect of Dehydrating via Active vs. Passive Heat Stress on Plasma Volume or Osmolality, Relative to the Effect of These Stressors per Se.

The physiological, perceptual, and functional effects of dehydration may depend on how it is incurred (e.g., intense exercise releases endogenous water via glycogenolysis) but this basic notion has rarely been examined. We investigated the effects of active (exercise) heat- vs. passive heat-induced dehydration, and the kinetics of ad libitum rehydration following each method. Twelve fit participants (five females and seven males) completed four trials in randomised order: DEHydration to -3% change in body mass (∆BM) under passive or active heat stress, and EUHydration to prevent ∆BM under passive or active heat stress. In all trials, participants then sat in a temperate-controlled environment, ate a standard snack and had free access to water and sports drink during their two-hour recovery. During mild dehydration (≤2% ∆BM), active and passive heating caused comparable increases in plasma osmolality (Posm: ~4 mOsmol/kg, interaction: p = 0.138) and reductions in plasma volume (PV: ~10%, interaction: p = 0.718), but heat stress per se was the main driver of hypovolaemia. Thirst in DEHydration was comparably stimulated by active than passive heat stress (p < 0.161) and shared the same relation to Posm (r ≥ 0.744) and ∆BM (r ≥ 0.882). Following heat exposures, at 3% gross ∆BM, PV reduction was approximately twice as large from passive versus active heating (p = 0.003), whereas Posm perturbations were approximately twice as large from EUHydration versus DEHydration (p < 0.001). Rehydrating ad libitum resulted in a similar net fluid balance between passive versus active heat stress and restored PV despite the incomplete replacement of ∆BM. In conclusion, dehydrating by 2% ∆BM via passive heat stress generally did not cause larger changes to PV or Posm than via active heat stress. The heat stressors themselves caused a greater reduction in PV than dehydration did, whereas ingesting water to maintain euhydration produced large reductions in Posm in recovery and therefore appears to be of more physiological significance.

An environmental impact study of inter-dental cleaning aids.

AIM: The aim of this study was to compare the environmental footprint of eight inter-dental cleaning aids. MATERIALS AND METHODS: A comparative life cycle analysis was conducted based on an individual person using inter-dental cleaning aids every day for 5 years. The primary outcome was a life cycle impact assessment. This comprised of 16 discrete measures of environmental sustainability (known as impact categories), for example, greenhouse gas emissions (measured in kilograms of carbon dioxide equivalent, or kg CO2 e), ozone layer depletion (measured in kilograms of chloroflurocarbon equivalent, or kg CFCe), and water use (measured in cubic metres). Secondary outcomes included normalized data, disability-adjusted life years, and contribution analysis. RESULTS: Inter-dental cleaning using floss picks had the largest environmental footprint in 13 of 16 impact categories. Depending on the environmental impact category measured, the smallest environmental footprint came from daily inter-dental cleaning with either bamboo inter-dental brushes (five impact categories, including carbon footprint), replaceable head inter-dental brushes (four impact categories), regular floss (three impact categories), sponge floss (three impact categories), and bamboo floss (one impact category). CONCLUSIONS: Daily cleaning with inter-dental cleaning aids has an environmental footprint that varies depending on the product used. Clinicians should consider environmental impact alongside clinical need and cost when recommending inter-dental cleaning aids to patients.

Impact of Dentine Pretreatment with Matrix Metalloproteinase Inhibitors on Bond Strength of Coronal Composite Restorations: A Systematic Review and Meta-analysis of In Vitro Studies.

OBJECTIVES: Matrix metalloproteinase (MMP) enzymes participate in collagen matrix degradation, including in dentine, potentially compromising bond strength. Therefore, MMP inhibitors have been hypothesized to improve restoration bond strength and stability. This systematic review aimed to evaluate the influence of different MMP inhibitors applied as dentine surface pretreatments on the immediate (24 hours) and longer term (months) bond strength of direct coronal composite restorations. MATERIALS AND METHODS: This systematic literature review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. A systematic literature search of three databases (Ovid MEDLINE, Ovid Embase, and Google Scholar) was conducted independently by two reviewers from inception to April 2022. An adapted quality assessment tool was independently applied by two reviewers for risk of bias assessment. STATISTICAL ANALYSIS: RevMan v5.4 software was used for meta-analyses. A random-effects model was used to generate mean differences with 95% confidence intervals for treatment and control comparisons. The Q-test and I2 -test were used to test for heterogeneity. The proportion of total variance across studies attributable to heterogeneity rather than chance was calculated. Overall effects were tested using the Z-test, while subgroup differences were tested using Chi-squared tests. RESULTS: Of 934 studies, 64 studies were included in the systematic review and 42 in the meta-analysis. Thirty-one MMP inhibitors were reported, three of which were included in the meta-analysis: 2% chlorhexidine (CHX), 0.3 M carbodiimide (EDC), and 0.1% riboflavin (RIBO). Pretreatment with 2% CHX for 30 and 60 seconds did not significantly improve bond strength compared with controls either immediately or after long-term ageing. However, pretreatment with 0.3 M EDC and 0.1% RIBO (but not CHX) significantly improved bond strength compared with control groups both immediately and over time. Most studies showed a medium risk of bias. CONCLUSIONS: These in vitro findings pave the way for rationale clinical trialing of dentine surface pretreatment with MMP inhibitors to improve clinical outcomes.

Incorporation of MMP inhibitors into dental adhesive systems and bond strength of coronal composite restorations: A systematic review and meta-analysis of in vitro studies.

Purpose: To systematically review in vitro studies that incorporated MMP inhibitors into adhesive systems in terms of the effect on immediate and aged bond strength of dental composite to dentine. Materials and methods: Independently, two reviewers conducted an electronic search in three databases (MEDLINE, EMBASE, and Google Scholar) following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P), up to 6 March 2022. Results: The search resulted in 894 papers, 33 of which were eligible to be included in the review; of those, 13 fulfilled the meta-analysis eligibility criteria. Nineteen inhibitors were used among the studies, and those included in the meta-analysis were 2%, 0.2% chlorhexidine (CHX), 5 µM GM1489, and 0.5%, 1% benzalkonium chloride (BAC). In the meta-analysis, while above inhibitors showed no adverse effect on bond strength, 0.2% CHX and 5 µM GM1489 caused a significant increase in immediate and 12-months bond strength. All other inhibitors resulted in a significant increase in bond strength at six months of ageing. Conclusions: Incorporation of MMP inhibitors into the adhesive system has no unfavourable effect on immediate bond strength but a favourable effect on longer-term bond strength. Additionally, inhibitors other than CHX could have similar or better effects on bond strength.

Renewal MI Dental Composite Etch and Seal Properties.

This study's aim was to assess whether the Renewal MI composite can self-etch enamel, seal sound cavities, and stabilize demineralized dentine. Etching was assessed using scanning electron microscopy (SEM). Cavity sealing was quantified using the ISO-11405 dye microleakage test. Demineralized dentine stabilization was evaluated by visualizing resin tag formation, enzyme activity and mineral precipitation at the adhesion interface. Renewal MI provided a mild etching of sound enamel in comparison with 37% phosphoric acid. It provided a comparable seal of sound cavities to Z250/Scotchbond Universal adhesive and a superior seal to Activa, Fuji IX and Fuji II LC. With demineralized dentine, Renewal MI formed 300-400 µm resin tags covering 63% of the adhesion interface compared with 55 and 39% for Z250/Scotchbond and Activa. Fuji IX and Fuji II LC formed no resin tags. A higher tag percentage correlated with lower surface enzyme activity. Unlike Activa and Fuji II LC, Renewal MI promoted mineral precipitation from simulated body fluid, occluding adjacent dentinal tubules within 6 months. These novel etching and sealing properties may facilitate Renewal MI's application in minimally invasive dentistry.

The environmental impact of community caries prevention - part 1: fluoride varnish application.

Background Healthcare is a significant contributor to climate change and planetary health. Prevention of oral disease, such as caries, is an important part of any mechanism to improve sustainability. Caries prevention includes community schemes such as water fluoridation, toothbrushing, or fluoride varnish (FV) application. The aim of this study was to quantify the environmental impact of FV application.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of a five-year-old child receiving two FV applications in a one-year period in schools and in dental practice.Results FV application in dental practice during an existing appointment had the lowest environmental impact in all 16 categories, followed by FV application in schools. FV application at a separate dental practice appointment had the highest impact in all categories, with a majority of the impact resulting from the patient travel into dental practice.Discussion FV application while a child is already attending dental practice (for example, at routine recall) is the most sustainable way to deliver FV. School FV programmes are an alternative, equitable way to reach all children who may not access routine care in dental practice.

The environmental impact of community caries prevention - part 2: toothbrushing programmes.

Introduction Community-level caries prevention programmes includes supervised toothbrushing in schools and the provision of toothbrushes and toothpaste. The environmental impact of these interventions is an important factor to consider when commissioning these services.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of a five-year-old child receiving one of two toothbrushing programmes over a one-year period; supervised toothbrushing in school, or the provision of toothbrushes and toothpaste.Results Supervised toothbrushing had a lower environmental impact than provision of toothbrushes and toothpaste in all 16 impact categories measured. The water use needed for children to brush their teeth was the greatest contributing factor to the provision of toothbrushes and toothpaste, accounting for an average of 48.65% of the impact results.Discussion All community-level caries prevention programmes have an associated environmental cost. LCA is one way to quantify the environmental impact of healthcare services and can be used along with cost and clinical effectives data to inform public healthcare policy. Organisations responsible for these programmes could use the results of this study to consider ways to reduce the environmental impact of their services.

The environmental impact of community caries prevention - part 3: water fluoridation.

Introduction Community-level interventions for the prevention of dental caries in children include fluoride varnish in schools, supervised toothbrushing in schools, the provision of toothbrushes and toothpaste and water fluoridation. The environmental impact of these interventions is an important factor to consider when commissioning these services.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of fluoridation of the public water supply for a five-year-old child over a one-year period. These results were compared to LCA data for fluoride varnish in schools, supervised toothbrushing and the provision of toothbrushes and toothpaste.Results When comparing community-level caries prevention programmes, water fluoridation had the lowest environmental impact in all 16 categories and had the lowest disability-adjusted life years impact.Discussion All community-level caries prevention programmes have an associated environmental cost. Water fluoridation performed well in this LCA study in all measures of environmental sustainability. The results of this study could be used, along with cost and clinical effectiveness data, to inform public healthcare policy.

A review of HTM 01-05 through an environmentally sustainable lens.

Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised, yet it is also essential that planetary harm (and therefore public harm) is minimised with respect to resource consumption, air pollution, environmental degradation etc.In 2013, the Department of Health introduced the Health Technical Memorandum (HTM) 01-05 providing dental practices with advice on patient safety when decontaminating reusable instruments in primary care. This paper provides a commentary on HTM 01-05 and similar decontamination guidance. We believe all decontamination documents needs to reflect the so-called 'triple bottom line' - the finance, social cost and impact on the planet.The authors provide an environmental commentary on a number of items mentioned in decontamination documents, including autoclaves (including the use of helix tests), disposable paper towels, undertaking hand hygiene, using a log book, plastic bag use, the use of personal protective equipment, remote decontamination units, single use instruments, single use wipes, disinfection chemicals (for example, sodium hypochlorite) thermal disinfection and wrapping of instruments.It is hoped, in the spirit of the ever-increasing numbers of papers published to highlight how healthcare (and dentistry) could become more sustainable, that these critiques will be taken in the spirit of providing a beginning of further discussion from an environmental perspective.

Variations in provision of dental general anaesthetic for children in England.

Introduction Dental general anaesthetic (DGA) remains one of the main modalities to deliver treatment to paediatric patients. The main central registry system which is used as a proxy measure of DGA provision is the Hospital Episode Statistics (HES) data on hospital admission of children for dental extractions. This database does not accurately reflect the number of DGAs as it omits non-hospital-based providers and the data includes treatment under sedation.Aims The aim is to describe the paediatric DGA service provision across England and determine type of provider (NHS Trusts or Community Dental Services [CDSs]), type of lists (extraction or comprehensive care) and the speciality planning the service.Methods Potential providers were identified using the provider-level analysis in HES database (for NHS trusts) and the NHS Business Services Authority and internet-based search engine (for CDS providers). All potential providers were contacted (n = 204) and provided with a pro forma to collect data.Results Response rate was 82% and 115 providers confirmed provision of paediatric DGA. These were mostly NHS trusts (72%). Not all providers appeared in the HES database (25%). Half of the providers provided separate lists for exodontia versus comprehensive care. Only 32% of the lists were planned by specialists in paediatric dentistry. All regions, apart from London, had some comprehensive care lists planned by non-paediatric dentists.Conclusion The results highlighted the inaccuracies in the HES, variation in service provision across England and the lack of paediatric speciality-led DGA services. Paediatric DGA needs to be better recorded and commissioned.