Darwinian Dentistry? Social Media, Smartphones and Selfie Sticks.

The COVID-19 pandemic produced numerous challenges for clinical dentistry which necessitated adaptation and innovation. This article will illustrate the use of selfie stick devices and ring lights for dental care practitioners to create customised 'selfie' videos of them using very effective cleaning devices on the patient's own smartphone. Because these short, engaging videos are now readily available to the patient at their home it reminds them which brushes to use, where and how. Patients are empowered by these videos which put them at the centre, reinforcing the key preventive message that they can improve and maintain their oral health by introducing effective oral hygiene behaviours. The many advantages, both for patients and for their practice teams, will be discussed in detail.

HPLC-DAD analysis, antifungal and antioxidant activity of Solanum dolichosepalum bitter extracts and fractions

Abstract Solanum dolichosepalum is a plant with anti-infective effects. It is a healing agent and has ethnopharmacological uses. In this study, the antifungal activity of extracts and fractions of this species on C. albicans and F. oxysporum was evaluated. The antioxidant activity was measured using the ABTS and DPPH methods, and by determining the total content of phenolic compounds. An HPLC-DAD qualitative analysis was carried out to identify phenolic compounds and alkaloids. Pearson's correlation coefficients were calculated. Inhibitory effects were found in all the extracts and fractions on the analyzed microorganisms. F. oxysporum was the microorganism most sensitive to the action of S. dolichosepalum extracts. All extracts and fractions showed antioxidant activity, with the acetone extract and the acetone fraction being those that generated the best results. The content of total phenolic compounds showed that acetone has a greater affinity with the phenolic compounds present in S. dolichosepalum. In this plant, p-Hydroxybenzoic, vanillic, ferulic, trans-cinnamic, caffeic, p-coumaric, and rosmarinic acids were found, as well as theobromine, quercetin, and luteolin. The content of total phenolic compounds was determined to be directly proportional to the inhibition of the ABTS and DPPH radicals, and the inhibition of the analyzed microorganisms. It was determined that the extracts and fractions obtained from S. dolichosepalum show antioxidant and antifungal activity.

Changes in Occlusal Philosophies for Full Mouth Rehabilitation.

This article reviews some of the main tenets of different occlusal philosophies involved in 'full mouth rehabilitation' and evolved since the late 19th century. This review is not intended as a comprehensive historical review of all the people who wrote, researched, or taught on the topic, and it is certainly not intended to disparage their well-meaning contributions. It is intended to highlight some of the changes that occurred in relation to full mouth rehabilitation occlusal concepts along with the dates when they were articulated.

Facts and Fallacies About Occlusal Philosophies for Full Mouth Rehabilitation.

This article reviews various full mouth rehabilitation occlusal concepts along with their main beliefs and controversies. Many of those occlusal teachings were well-meant at the time they were introduced. However, closer examination reveals that many of them involved serious destruction of sound tooth tissue - without delivering many of their purported benefits.The biologic and structural disadvantages of 'subtractive' dental procedures, which were, and still are, undertaken to provide traditional full mouth rehabilitation are discussed. Those approaches are contrasted with the proven advantages of minimally destructive additive techniques, which can solve frequently encountered clinical problems previously deemed to require traditional 'full mouth rehabilitations'. Pragmatic clinical cases are used to illustrate how to solve common clinical problems by using minimally destructive means, without causing structural damage to residual sound tooth tissue.

Instagram Dentistry.

Instagram, a photo and video social networking site, is gaining popularity in the dental world and it is easy to see why this is so. Instagram's potential to share information in an engaging way allows dental professionals to share clinical work and provides a unique way of learning.Advertising on Instagram has blossomed. Some of this is for self-promotional reasons, for practice building, or for marketing of new techniques and products by manufacturers. One ought to be cautious about the implications of some patients' quest for 'dental perfection'. That is especially the case when destructive dentistry is being undertaken by dentists trying to replicate what they have seen on Instagram in potentially much more challenging patients. Some of those demanding patients request very ambitious treatments with sometimes hugely unrealistic expectations. Arguably, Instagram could be the new major trend in dentistry.

The legal fallacies about 'if it was not written down it did not happen', coupled with a warning for 'GDC experts'.

It is a fallacy that 'if it was not written down it did not happen'. The expression has become something of a mantra among certain dental 'educationalistas' and has been recited so often by some plaintiffs' tame 'experts' and by some lawyers that many people now believe that it is true. As a matter of law, it is not. This article challenges the correctness of that oft-repeated assertion - because it is not a law of evidence and neither is it even a law of logic.A lot of truly important diagnostic information can be gleaned by listening carefully to a patient with both of an interested clinician's eyes and ears being fully open and being 'fully present', rather than furiously scribbling notes. In fact, overtly concentrating on writing or typing notes, rather than sympathetically engaging face-to-face with a patient, can often detract from the chances of that patient being open and honest enough to reveal the bits of information that are so vital in getting the full diagnostic picture. A dictaphone is a useful, traditional and acceptable way of summarising all the important and available information immediately after the consultation.The second part of the article draws attention to the potential for imprisonment for up to two years of 'pseudo-experts' who stray beyond their remit - or who make false, rash or inappropriate allegations in their report when this is accompanied by a statement of truth.

Is 'Digital Dentistry' Dangerous for Teeth? Problems Associated with Zirconia and CAD/CAM Restorations.

The increasing prescription of metal-free dental restorations has come about as a result of various patient demands and somewhat narcissistic expectations. However, some dental professionals have contributed to the rise in popularity of these materials and techniques. This article highlights the potential pitfalls of undertaking inherently destructive procedures, particularly when performed for questionable "cosmetic" reasons.

Optimizing the primary particle size distributions of pressurized metered dose inhalers by using inkjet spray drying for targeting desired regions of the lungs.

Conventional suspension pressurized metered dose inhalers (pMDIs) suffer not only from delivering small amounts of a drug to the lungs, but also the inhaled dose scatters all over the lung regions. This results in much less of the desired dose being delivered to regions of the lungs. This study aimed to improve the aerosol performance of suspension pMDIs by producing primary particles with narrow size distributions. Inkjet spray drying was used to produce respirable particles of salbutamol sulfate. The Next Generation Impactor (NGI) was used to determine the aerosol particle size distribution and fine particle fraction (FPF). Furthermore, oropharyngeal models were used with the NGI to compare the aerosol performances of a pMDI with monodisperse primary particles and a conventional pMDI. Monodisperse primary particles in pMDIs showed significantly narrower aerosol particle size distributions than pMDIs containing polydisperse primary particles. Monodisperse pMDIs showed aerosol deposition on a single stage of the NGI as high as 41.75 ± 5.76%, while this was 29.37 ± 6.79% for a polydisperse pMDI. Narrow size distribution was crucial to achieve a high FPF (49.31 ± 8.16%) for primary particles greater than 2 µm. Only small polydisperse primary particles with sizes such as 0.65 ± 0.28 µm achieved a high FPF with (68.94 ± 6.22%) or without (53.95 ± 4.59%) a spacer. Oropharyngeal models also indicated a narrower aerosol particle size distribution for a pMDI containing monodisperse primary particles compared to a conventional pMDI. It is concluded that, pMDIs formulated with monodisperse primary particles show higher FPFs that may target desired regions of the lungs more effectively than polydisperse pMDIs.

Biomonitoring of trace metal pollution using the bivalve molluscs, Villorita cyprinoides, from the Cochin backwaters.

Trace metal concentrations in the muscle of the bivalve Villorita cyprinoides from the Cochin backwaters (southwest coast of India) were investigated during the monsoon, post-monsoon and pre-monsoon periods. The seasonal average ranges of metals (µg g(-1), dry weight) in the bivalve were as follows: Fe (18,532.44-28,267.05), Co (23.25-37.58), Ni (10.56-19.28), Cu (3.58-11.35), Zn (48.45-139.15), Cd (1.06-1.50) and Pb (3.05-4.35). The marginally elevated metal concentrations in bivalve muscles are probably related to high influx of metals as a result of pollution from the industries and agricultural fields with consequent increased bioavailability of metals to the bivalve. Evaluation of the risks to human health associated with consumption of the bivalves suggested that there is no health risk for moderate shellfish consumers. A regular and continuous biomonitoring program is recommended to establish V. cyprinoides as a bioindicator for assessing the effects of trace metal pollution and to identify future changes to conserve the "health" of this fragile ecosystem.

Impact of eutrophication on the occurrence of Trichodesmium in the Cochin backwaters, the largest estuary along the west coast of India.

Phytoplankton studies in early 1970s have shown the annual dominance of diatoms and a seasonal abundance of Trichodesmium in the lower reaches of the Cochin backwaters (CBW) and adjacent coastal Arabian Sea during the pre-summer monsoon period (February to May). Surprisingly, more recent literature shows a complete absence of Trichodesmium in the CBW after 1975 even though their seasonal occurrence in the adjacent coastal Arabian Sea continued without much change. In order to understand this important ecological feature, we analyzed the long-term water quality data (1965-2005) from the lower reaches of the CBW. The analyses have shown that salinity did not undergo any major change in the lower reaches over the years and values remained >30 throughout the period. In contrast, a tremendous increase was well marked in levels of nitrate (NO(3)) and phosphate (PO(4)) in the CBW after 1975 (av. 15 and 3.5 µM, respectively) compared with the period before (av. 2 and 0.9 µM, respectively). Monthly time series data collected in 2004-2005 period from the lower reaches of the CBW and coastal Arabian Sea have clearly shown that the physical characteristics like salinity, temperature, water column stability, and transparency in both regions are very similar during the pre-summer monsoon period. In contrast, the nutrient level in the CBW is several folds higher (NO(3), 8(;) PO(4), 4; SiO(4), 10; and NH(4), 19 µM) than the adjacent coastal Arabian Sea (NO(3), 0.7; PO(4), 0.5; SiO(4), 0.9; and NH(4), 0.6 µM). The historic and fresh time series data evidences a close coupling between enriched levels of nutrients and the absence of Trichodesmium in the Cochin backwaters.

A novel method to produce small droplets from large nozzles.

This work presents a new method to generate droplets with diameters significantly smaller than the nozzle from which they emerge. The electrical waveform used to produce the jetting consists of a single square negative pulse. The negative edge of the pressure wave pulls the meniscus in, overturning the surface in such a way that a cavity is created. This cavity is then forced to collapse under the action of the positive edge of the pressure wave. This violent collapse produces a thin jet that eventually breaks up and produces droplets. Four droplet generator prototypes that demonstrate the capabilities of this novel mechanism are described. It is also shown that the proposed mechanism extends the existing limits of the commonly accepted inkjet operating regime.

Ethical marketing in 'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 3.

UNLABELLED: This, the third and final article in this series on ethical marketing, makes it clear that cosmetic dentistry is not a guaranteed one-way ticket to happiness for either patients or dentists, but it can be for lawyers. In fact, this area of dentistry is fraught with many dangers for the unwary patient and even for the enthusiastic or experienced dentist. In general, it is not at all wise to raise patient expectations beyond that which is definitely going to be easily achievable in his/her particular case. CLINICAL RELEVANCE: If things go wrong with extensive cosmetic dentistry, or are judged as being suboptimal, or unacceptable, by the patient, then that dentist may become liable for all the remakes of that elective cosmetic dentistry for the lifetime of the patient, together with all the associated general and specific damages. This is because, if the elective cosmetic dentistry had not been done, the patient would not have needed to have the remakes. Informed consent is a major issue with cosmetic dentistry, as is avoiding any possible claims for breach of contract, which could be verbal, implied or written.

Ethical marketing in'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 1.

UNLABELLED: Prior to undertaking any elective,'cosmetic' dental procedures, it is vital for the treating dentist to discuss the merits and drawbacks of all viable options. It is important that the patient understands what the consequences and limitations of treatment are likely to be, and what the potential failures could entail later in his/her life. Informed consent should be obtained (preferably in writing) and the clinical notes and records should be clearly documented, with accurate and concise details provided of all the investigations carried out, and their findings, as well as including details of the various discussions that have taken place. Dentists need to be aware of the existence of heightened expectations in this group of patients and be cautious about accepting patients who have unrealistic 'cosmetic' expectations. Where possible, cosmetic or aesthetic dental treatment should be provided which is minimally destructive and, in the long-term, be in the 'best interests' of the patient. Important matters such as the gaining of informed consent and maintaining meticulous, contemporaneous dental records will also be emphasized. It is hoped that the article will provide clear definitions of some commonly used terms such as 'ethical marketing', 'ethics', and 'values', which are often used in association with the marketing, planning and undertaking of supposedly 'cosmetic' dental procedures. The important role of less invasive alternative treatment options will also be emphasized. CLINICAL RELEVANCE: The aims of this article are to consider the common pitfalls that may arise when contemplating the marketing and provision of invasive,'cosmetic, dental restorations and to discuss how best to avoid a dento-legal claim where such treatment plans may not fulfil the patient's desired outcome.

Ethical marketing in 'aesthetic' ('esthetic') or 'cosmetic dentistry' part 2.

UNLABELLED: This is the second article in a series of three. It is essential to find out from patients what it is that they hope to achieve when requesting an improvement in their dental appearance. Their expectations, hopes and fears need to be explored in detail. The long-term biologic costs of some invasive procedures need to be explained to patients in advance so that they can make properly informed decisions. Failure to do so renders the practitioner vulnerable to a charge of behaving unethically. The differences between ethical marketing and selling are explained including the historic development of marketing. CLINICAL RELEVANCE: A practical approach, using a modification of the Edward de Bono Six Thinking Hats model is described to help ethical practitioners to develop sound treatment plans when dealing with complex aesthetic problems.

Toxic metals enrichment in the surficial sediments of a eutrophic tropical estuary (Cochin backwaters, Southwest Coast of India).

Concentrations and distributions of trace metals (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn) in surficial sediments of the Cochin backwaters were studied during both monsoon and pre-monsoon periods. Spatial variations were in accordance with textural charaterstics and organic matter content. A principal component analysis distinguished three zones with different metal accumulation capacity: (i) highest levels in north estuary, (ii) moderate levels in central zone, and (iii) lowest levels in southern part. Trace metal enrichments are mainly due to anthropogenic contribution of industrial, domestic, and agricultural effluents, whose effect is enhanced by settling of metals due to organic flocculation and inorganic precipitation associated with salinity changes. Enrichments factors using Fe as a normalizer showed that metal contamination was the product of anthropogenic activities. An assessment of degree of pollution-categorized sediments as moderately polluted with Cu and Pb, moderately-to-heavily polluted with Zn, and heavily-to-extremely polluted with Cd. Concentrations at many sites largely exceed NOAA ERL (e.g., Cu, Cr, and Pb) or ERM (e.g., Cd, Ni, and Zn). This means that adverse effects for benthic organisms are possible or even highly probable.

Biologically based restorative management of tooth wear.

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as "The Daughter Test", this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles.

A restorative approach to the clinical and aesthetic management of adult patients with Class II division 2 incisor malocclusions.

UNLABELLED: A Class II division 2 incisor malocclusion may be a cause of aesthetic and/or functional concern for some affected patients. Their particular concerns may include dark spaces around the misaligned teeth or uneven gingival contours. Orthodontic and/or orthognathic treatment can address some of these problems but frequently involves lengthy and expensive treatment in the adult dentition. Sadly, such treatment often produces an unstable result, with significant drawbacks such as the requirement for long-term retention. This article aims to describe alternative strategies for managing patients with this incisor malocclusion. CLINICAL RELEVANCE: This paper outlines a quicker, pragmatic and minimally destructive restorative treatment alternative to conventional orthodontic treatment and the associated long-term retention.

Bleaching and bonding for the older patient.

UNLABELLED: Older people who remain reasonably well may wish to maintain or enhance their dental and oral appearance, preferably at minimal biologic and financial costs. Bleaching and bonding represents a very good treatment option and a sensible strategy for this group. Bleaching addresses the discoloration, while direct composite bonding can improve the shape of worn, or otherwise unaesthetic, teeth without damaging the structure or health of the residual tooth tissue. This pragmatic treatment is well tolerated by older patients. The visual and functional improvements are greatly appreciated by this group, partly because of the non-destructive and affordable nature of the benefits. CLINICAL RELEVANCE: Bleaching and bonding represents a proven, sensible, pragmatic, affordable and practical approach to managing the aesthetic problems of older patients, and the benefits are achievable without destroying their residual sound tooth tissue.