Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation. Recommendations • Preventative oral care must be delivered to patients whose cancer treatment will affect the oral cavity, jaws, salivary glands and oral accessibility. (G) • Close working and communication between the surgeons, oncologists and restorative dental specialists is important in ensuring optimal oral health outcomes. (G) • Intensity-modulated radiotherapy has been shown to reduce long-term xerostomia and should be offered to all appropriate patients. (R) • If patients are deemed at risk of trismus they should be warned and its progressive and potentially irreversible nature explained. (G) • Where it is known that adjuvant radiotherapy will be given, extractions should take place at primary surgery to maximise the time for healing and minimise the number of surgical events for patients. (G) • Osseointegrated implants should be considered for all patients having resection for head and neck cancer. (G).

The reasons for the extraction of various tooth types in Scotland: a 15-year follow up.

OBJECTIVES: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies. METHODS: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction. RESULTS: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes. CONCLUSIONS: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

The reasons for extraction of permanent teeth in Scotland: a 15-year follow-up study.

AIMS: Although Scotland has the highest proportion of edentulous adults in the UK, the frequency of edentulousness has fallen by 21% during the last 20 years. This study, carried out in 1999, was designed to establish whether the reasons for tooth loss have also changed since 1984 when they were last determined. METHODS: The Scottish Dental Practice Board provided the names of every fourth dentist on its list among which 425 general dental practitioners were identified. They were asked to record permanent tooth extractions for 1 week, specifying the age, sex and dental attendance of patients who underwent extractions and the reasons for these extractions. 352 dentists took part: a response rate of 82.8%. RESULTS: The study confirmed that there has been a reduction in the number of extractions between 1984 and 1999: there were 25% fewer teeth extracted per patient and 30% fewer per dentist per week. From 0-20 years of age, orthodontics has replaced caries as the commonest reason for extraction and in all age groups over 20 years, caries has become the commonest reason in contrast to 1984 when periodontal disease was the principal reason in patients over 40 years old. CONCLUSIONS: Caries and its sequelae remain the most important cause of tooth loss throughout adult life in Scotland and, therefore, caries prevention and maintenance of restorations are of great importance at all ages.

The influence of specialty training and experience on decision making in endodontic diagnosis and treatment planning.

AIM: The purpose of this study was to compare the diagnostic and treatment-planning decision making of cohorts of dental surgeons with different experiences and specialty backgrounds. METHODOLOGY: Periapical radiographs of 20 teeth in patients referred for an opinion regarding the provision of endodontic surgical retreatment were taken using a paralleling technique and a film holder. The radiographs were photographed and black and white photographic prints produced to provide an image 10.5 times larger than the original radiograph. Each image was related to a clinical scenario. Each participant was asked to assess whether a periradicular lesion, as manifested by a radiolucency, was present and what clinical management would be prescribed. Ten participants in each of seven groups took part in the study. These groups were chosen to represent those dentists who were most likely to be involved in decision making in similar cases. RESULTS: In 12 out of 20 cases interobserver agreement for radiographic analysis was 'excellent' (above 90%) or 'good' (between 70 and 90%). There was less agreement for treatment decisions than for radiographic analysis and the order of agreement for cases for diagnosis was not the same as for treatment. No case achieved 'excellent' percentage interobserver agreement. The average percentage interobserver agreement of the endodontists was significantly greater than the average percentage interobserver agreement for the other groups for both radiographic assessment and treatment decisions. CONCLUSIONS: Differences in specialty backgrounds amongst the participants in this study affected both endodontic diagnostic and treatment decisions. Endodontists showed the most consistent agreement amongst the specialty groups.

Rate of loss of irradiated polyglactin 910 (Vicryl Rapide) from the mouth: a prospective study.

We aimed to find out how long irradiated polyglactin 910 (Vicryl Rapide) remained in the oral tissues and to investigate the effect of chlorhexidine mouthwash on absorption time and bacterial growth on sutures. Twenty-one volunteers each had two Vicryl Rapide sutures placed intraorally under local anaesthesia. Ten of these subjects used chlorhexidine mouthwash twice daily. After 7 days, one suture was removed to be cultured for aerobic and anaerobic bacteria. The other was monitored for time from insertion to loss. The median survival value was 3 days (range 1-13). The median number of days to suture loss was less in the chlorhexidine group (3, range 1-11) than in the control group (4, range 1-13) but this was not significant. There were no significant differences in aerobic and anaerobic counts between the two groups. Vicryl Rapide may be useful for intraoral use.

Techniques to increase the response rate in follow-up studies: results of a pilot test.

As a part of the design and implementation of a caseload weighting system, Arkansas Rehabilitation Services is adopting a revised client data system. To assess the validity of the data collected in the new system a follow-up survey for recently closed clients has been designed; and to insure the adequacy of the survey design several issues were considered. These included overall survey and questionnaire design. The process, designed to maximize useful information collected with limited resources, resulted in a telephone survey augmented by mail and personal interviews. The survey procedures and instrumentation were pilot tested for two months with 629 clients. This resulted in major modifications in questionnaire design and brought to light easily adopted procedural improvements resulting in less ambiguity, improved readibility, increased response rate and reduced response bias. Using the described survey methods the investigators observed an overall response rate of 50.8% which compares very favorably with that reported in other studies similar in nature.