Is the Use of Antimicrobial Photodynamic Therapy or Systemic Antibiotics More Effective in Improving Periodontal Health When Used in Conjunction with Localised Non-Surgical Periodontal Therapy? A Systematic Review.

Periodontal disease can be treated in several ways. This paper reviewed whether antimicrobial photodynamic therapy (aPDT) in addition to scaling and root planing (SRP) produces improved clinical results over systemic antibiotics (ABs) in conjunction with SRP in adults with periodontitis. Studies were searched using the following electronic databases: MEDLINE, the Cochrane Database of Systematic Reviews, and the Web of Science Core Collection up to and including November 2018. Four randomized controlled trials (RCTs) were reviewed to maximise the reliability of the evidence. All participants suffered from either chronic or aggressive periodontitis and each study contained SRP as an adjunct to ABs or aPDT. To determine whether groups showed improvement after treatment, the outcome parameters chosen were probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Despite finding significant improvements in all groups, the differences among groups were not consistently statistically significant. The lack of homogeneity in the results among these studies indicates that it was not possible to determine a conclusion about whether aPDT or AB as an adjunct to SRP provides better improvements in periodontitis as measured by PD, CAL, and BOP. Further studies with more similar study designs are required before firm conclusions can be deduced.

Between fairness and fear-Dental undergraduates' attitudes towards objective structured clinical examinations.

INTRODUCTION: Objective structured clinical examinations (OSCEs) are an established method of assessment for dental undergraduates. There is little published dental education research exploring the views of undergraduates towards OSCEs. AIM: To explore and describe the views of dental undergraduates towards OSCEs. METHOD: A sequential mixed methods design was applied. This included a cross-sectional survey of all 204 dental undergraduates in Years 2, 3 and 4 within a UK dental school using an anonymous self-report online questionnaire (response rate 57%), which was followed by two focus group interviews of n = 10 Year-2 students. RESULTS: Most students gave positive views regarding the OSCE form of assessment. Questionnaire data highlighted that students felt that the OSCE tested their diagnostic, clinical and communication skills, and covered a wide range of skills and disciplines. Students also generally saw them as a useful educational exercise that went beyond testing recall of facts. Most students thought that the OSCEs were "fair" assessments. Negative views focused around student lack of preparation for them, especially in earlier years. Focus group data explored further these concerns but also emphasised the need for more student-centred support pre-OSCE. CONCLUSION: Objective structured clinical examinations can be an anxiety-inspiring form of assessment for students in the early years of the programme. Dental educators need to be more aware of these concerns to develop strategies to increase student preparedness for OSCEs without increasing stress.

An Implant-Retained Obturator ­ A Case Study.

This case describes the oral rehabilitation of a patient following maxillary hemi-section due to squamous cell carcinoma of the palate. Planned treatment was construction of a maxillary implant-supported obturator. Two dental implants were placed in his maxilla to aid the support and retention of an obturator. However, owing to bone availability, their angulation was suboptimal and compromised the retention of the obturator. This case describes alternative implant attachments to aid the retention and stability of implant-retained dentures constructed in cases with suboptimal implant placement. Clinical relevance: This case highlights the importance of careful planning for implant placement, and reinforces the need to plan the prostheses before implant surgery. This case highlights possible difficulties that can arise if implants are non-ideally angulated, and how to adapt restorations to manage such difficulties in cases with maxillary removable prostheses.

Calcifying Acne: An Unusual Extraoral Radiographic Finding.

Calcinosis cutis is a condition of accumulation of calcium salts within the dermis leading to the formation of a calcified mass. This complication has been reported in acne vulgaris and other systemic metabolic disorders. This paper presents a rare case of calcinosis cutis in a 14-year-old male which was found at a routine orthodontic assessment.

The Association between Postgraduate Studies, Gender and Qualifying Dental School for Graduates Qualifying from UK Dental Schools between 2000 and 2009.

Various factors will influence a dental graduate's decision to undertake postgraduate education and training, including encouragement from family, partners and staff at individual dental schools, although there is currently little information available regarding the number and distribution (by dental school) of recent dental graduates undertaking postgraduate studies. The aim of this study was to analyse data on postgraduate qualifications achieved by dentists who graduated from UK dental schools between 2000 and 2009 and relate this to graduate gender. Data were collected from the General Dental Council (GDC) in an anonymous electronic format, analysed and ordered by year of graduation, dental school, gender and type of postgraduate qualification. Nearly one-quarter (24%) of the dentists that graduated between 2000 and 2004 completed postgraduate studies, with more females (26%) than males (23%) obtaining further postgraduate qualifications. Overall, Bristol produced the largest proportion of graduates completing postgraduate study (39%) and of these the largest proportion of female graduates (45%). Glasgow produced the largest proportion of male graduates completing postgraduate study (37%). Membership of the Faculty of Dental Surgery (MFDS), one of the Royal Colleges, was the most popular postgraduate qualification obtained followed by Membership of the Faculty of General Dental Practitioners UK (MFGDP). This study provides insight into postgraduate studies undertaken by UK dental graduates. An increasing proportion of females are gaining Bachelor of Dental Surgery (BDS) qualifications and therefore the number of female dental graduates obtaining postgraduate qualifications is likely to increase further. This also suggests the male domination of the dental profession is likely to decrease.

Should Undergraduate Lectures be Compulsory? The Views of Dental and Medical Students from a UK University.

Formal lectures have been a traditional part of medical and dental education, but there is debate as to their compulsory status. This study was designed to explore dental and medical students' views on compulsory lectures and the use of Video-Recorded Lectures (VRL). A cross-sectional study of University of Bristol students in Years 2 to 4 was conducted using an online questionnaire. The majority of both dental (76%) and medical (66%) students felt lectures should be non-compulsory. The most common learning resources used by both dental and medical students were live lectures, lecture handouts and VRL. The majority of both dental (84%) and medical (88%) students used VRL. Most students attended lectures all of the time both before and after the introduction of VRL, even though most dental and medical students believe lectures should be non-compulsory. VRL is a popular learning resource. These findings tie-in with General Dental Council and General Medical Council recommendations that encourage self-directed learning. Dental and Medical schools should offer a range of learning resources and make use of current technology, including the use of VRL.

Denture Stomatitis ­ A Clinical Update.

Denture stomatitis is a benign condition, usually asymptomatic, that can affect edentulous patients. Studies have reported a prevalence of denture stomatitis affecting over 75% of denture wearers and, whilst the aetiology may be multifactorial, Candida albicans has a strong association with the condition, along with denture trauma and poor denture hygiene being associated local risk factors. This paper describes the aetiology, diagnosis and treatment of denture stomatitis, with the aim of helping clinicians to provide appropriate management of this condition. Clinical relevance: Denture stomatitis can be a recurrent problem amongst denture wearers and is often asymptomatic to the patient. Dental practitioners should be able to identify and manage this condition. Clinical relevance: Denture stomatitis can be a recurrent problem amongst denture wearers and is often asymptomatic to the patient. Dental practitioners should be able to identify and manage this condition.

Undergraduate Confidence When Undertaking Root Canal Treatment and Their Perception of the Quality of Their Endodontic Education.

The General Dental Council expects graduating dentists to be competent at treating pulpal disease. Previous studies have found dental undergraduates to have low levels of confidence with respect to endodontic treatments. The aim of this study was to investigate the confidence of undergraduate dental students at the University of Bristol when performing root canal treatment, and to investigate their perception of the quality of their endodontic education. An anonymous questionnaire, based upon one used in a 2015 study at Cardiff University, was distributed to all (n = 204) undergraduate students in Years 3-5 at the University of Bristol. The results were analysed using the Statistical Package for the Social Sciences software (SPSS). There was a 59% (n = 120) response rate and a significant (p < 0.01) difference in confidence levels for root canal treatments (RCTs) completed between these students. All (100%) Year-5 students felt confident in completing anterior RCTs, and 91% felt confident in completing posterior RCTs. The majority (93%) of Year-4 students felt confident in completing anterior RCTs, and 77% felt confident in completing posterior RCTs. Over one-half (56%) of Year-3 students felt confident in anterior RCTs and 17% in posterior RCTs. With respect to the individual stages of RCT (access cavity, cleaning and shaping of root canal system, and obturation/filling), results showed that there was a significant difference (p < 0.01) in confidence levels between year groups. Many students thought the amount of time spent on endodontic teaching and the quality of teaching to be satisfactory. Improvements suggested for future endodontic teaching included higher numbers of staff supervision and additional endodontic practice on extracted teeth before seeing patients. There was a strong association between students' clinical experience and their levels of confidence when completing RCT. Increasing the amount of clinical experience of RCTs could enhance students' confidence further.

Tobacco, Alcohol and Drug Use among Dental Undergraduates at One UK University in 2015.

The aim of this study was determine the prevalence of tobacco, alcohol and illicit substance use among dental undergraduates at one UK university in 2015. A cross-sectional survey of all 344 dental undergraduates using an anonymous self-report questionnaire was carried out. The response rate was 77%, of which 29% were male and 71% female. Tobacco smoking was reported by 23.6% of males and 12.2% of females, with only 1.6% of females reporting to smoke ≥10 cigarettes per day. Alcohol consumption was reported by 85.5% of males and 84% of females, and reported levels of alcohol consumption increased since becoming undergraduates. Binge drinking was reported by 35.3% of males and 41% of female students. Only 2.6% of males and 0.5% of females reported to be current regular users of cannabis. The vast majority of respondents claimed to have never used any illicit substance. The only other reported regularly used substances by males was Ecstasy (1.3%) and by females were LSD (0.5%), Ecstasy (1.5%), Cocaine (0.5%), Inhalants (0.5%) and Ketamine (0.5%). These results are encouraging. Fewer students reported smoking than in the general population, levels of binge drinking were considerably lower than previously reported figures, as were the numbers of regular users of cannabis and other illicit substances.

Dental Undergraduate Views of Objective Structured Clinical Examinations (OSCEs): A Literature Review.

Objective Structured Clinical Examinations (OSCEs) are widely used in dental undergraduate assessment, often determining progression or graduation. Student evaluation of this assessment process is important, and this includes identifying the views of the student. The aim of this paper is to present a review of the current literature regarding dental student perceptions of OSCEs. A search of the PubMed database covering the period 1975 to 2015 identified 121 possible papers from which only six were suitable for review. The remaining papers were excluded due to them not reporting on dental undergraduate views. Students perceived the OSCE to be a valid assessment in three studies, but not in one. The educational benefit of an OSCE is well supported by these studies. OSCEs can induce high levels of anxiety compared to other forms of assessments, but this did not affect student performance. The majority of students would chose to have a similar format of assessment again, showing support for OSCEs. Further research using larger cohorts of students could be undertaken in order to support these finding which would give added evidence for the continuing use of OSCEs as a valid method of both dental undergraduate education and assessment.

Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists.

The aim of this study was to describe Dental Foundation year one dentists' attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient's values (p < 0.001) in decision making, but similar to the patient's friend's/relative's values (p = 0.1). In addition, the trainees perceived the patient's values to be less important than their friend's/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools' ability to foster ethical and professional values among dentists.

The Overall Survival, Complication-Free Survival, and Related Complications of Combined Tooth-Implant Fixed Partial Dentures: A Literature Review.

This paper reviews the literature regarding possible complications, complication-free survival, and overall survival of fixed dental prostheses that use both implants and natural teeth as abutments. The paper also provides clinical guidelines for treatment based on this literature review. An electronic search utilizing the MEDLINE, BIOSIS Citation Index, and Web of Science™ Core Collection databases was undertaken, and a review of the 25 selected texts studying 22 different patient cohorts was carried out. From a total of 1610 implants reviewed, 40 were lost (33 due to loss of integration and 7 due to fracture), whereas, out of a total of 1301 teeth, 38 were lost, of which 16 were due to fracture. Seventy-three cases of tooth intrusion were detected. From a total of 676 frameworks reviewed (metal n = 645, Zirconia n = 31), 7 fractured, while veneer material fracture occurred in 70 out of 672 bridges. Overall, 502 out of 531 tooth-implant fixed prostheses (TIPFs) remained functional, and 336 out of 439 prostheses showed no technical or biological complications and remained functional. Rigid TIFPs permanently cemented to teeth with sufficient coronal structure and with limited use of prosthetic attachments offer a good long-term treatment option to patients with good oral hygiene following sound implant placement. This mode of treatment should be used when free-standing implant-supported options may not be possible. Larger randomized control studies and other clinical studies comparing tooth-to-implant-connected treatment with other forms of treatment are needed to better understand the place of TIFP treatment in oral rehabilitation.

An Ingested Orthodontic Wire Fragment: A Case Report.

Accidental ingestion or inhalation of foreign bodies has been widely documented, including incidents which occur whilst undertaking dental treatment. Most ingested objects pass through the gastrointestinal tract (GIT) spontaneously, but approximately 10%-20% need to be removed endoscopically and 1% require surgery. This case reports a complication arising from the accidental loss of an archwire fragment during maxillary archwire placement. It describes the immediate and subsequent management, including the use of radiographs to track the passage of the fragment through the gastro-intestinal tract. This case stresses the vigilance that dentists must take to prevent inhalation or ingestion of foreign bodies and the consequences of time-delays when management decisions are needed.

Final-Year Dental Undergraduate Attitudes towards Specialisation.

The aim of this study was to explore the attitudes towards postgraduate specialisation of final-year students at one UK dental school and to identify any possible influencing factors. A cross-sectional survey of all 73 final-year students using an anonymous self-report questionnaire was carried out. The response rate was 79%, of which nearly two-thirds were female. Age, ethnicity and parental occupation did not have an effect on the intention to specialise, although student gender did, with more females not wishing to specialise (p = 0.006). Having a 'talent in the field' had the largest positive influence on pursuing a specialist career (37.9% of responses), whilst the length of time needed to obtain a specialist qualification was seen as the largest negative influence (41.1% of responses). The two most popular subjects were Restorative Dentistry and Orthodontics with 24.1% and 20.7% of students listing them as their first choices, respectively. Further research could be carried out to determine if the intentions of UK undergraduates to specialise will meet the increasing specialist oral health needs of the population and which could ultimately influence future dental workforce planning.

Bilateral Transverse Mandibular Second Molars: A Case Report.

Impaction of mandibular second permanent molars is a rare occurrence, with prevalence rates reported to be between 0.65% and 2.0%. In the absence of systemic conditions, impactions are usually unilateral. There appears to be no consensus as to the optimal treatment for impacted mandibular second molars and treatment plans will be based upon the individual case. Treatment may involve orthodontics and/or various surgical techniques, and early diagnosis is important. This paper presents an unusual case of bilateral transverse impaction of both mandibular second and third molars that was diagnosed at 18 years of age. All impacted molars were extracted.