A mini outbreak of human metapneumovirus infection with severe acute respiratory symptoms in a selected group of children presented to a teaching hospital in Sri Lanka.

Human metapneumovirus (hMPV) of the family Paramyxoviridae is a relatively new virus causing severe acute respiratory tract infections (SARI) in children. Data on hMPV infection in Asia including Sri Lanka is limited. We aimed to detect respiratory viruses including hMPV in a selected group of children affected by a small outbreak of SARI presented to the Teaching Hospital, Peradeniya (THP), Sri Lanka in 2014. Nasopharyngeal aspirates (NPA) were obtained from 21 children with SARI and tested for hMPV, influenza A and B, parainfluenza 1, 2 and 3 (PIV 1-3), adenovirus and respiratory syncytial virus (RSV) antigens using an immunofluorescence assay (IFA). In addition, a one step RT-PCR was done for the detection of hMPV from the viral RNA extracts. Of the 21 NPA samples tested for respiratory viral antigens by IFA, two were positive for RSV (9.5%), one was positive for influenza A (4.8%) and one was positive for both adenovirus and PIV-2 (4.8%). Of the 21 NPA viral RNA extracts tested by RT-PCR, 18 (86%) were positive for hMPV, in which 2 were co-infected with RSV and influenza A virus, respectively. hMPV was the predominant cause of SARI outbreak (2014) in children presented to the THP, Sri Lanka.

The prevalence of dentine hypersensitivity among adult patients attending a university dental clinic

Objective: To assess the prevalence of dentine hypersensitivity (DH) in an adult population and explore association with sociodemographic variables, dietary habits and oral health behaviours. Design and Methodology: Cross-sectional survey of consecutive dental patients (18 years and over) attending the UWI School of Dentistry polyclinic. Following informed consent, dental examinations were undertaken by two calibrated dentists. Presence of DH was assessed clinically by sensitivity to an air syringe on individual teeth. Patients were also administered a questionnaire which included age, gender, occupation, medical and dental history, brushing and dietary history. Data were processed using statistical software (SPSS version 24). Association between variables were analyzed using the Chi-Square test. Results: 300 patients participated. Age range 18 ­ 81years, mean 44.7 years (SD 15.69). 69% were female and the main ethnic groups were African (45.7%),Indian (30%) and mixed (23%). 48.3% were in employment. Over half of the participants (54.9%) reported a history of sensitive teeth and 52% reported sensitivity to the air syringe on one or more teeth. A history of sensitive teeth was significantly associated with gender (female), frequent consumption of citrus fruits and citrus juice, history of teeth grinding or clenching and twice daily tooth brushing (Chi-square test p <0.05). Conclusions: Prevalence of dentine hypersensitivity was high among this sample of dental patients and associated with gender, dietary practices, tooth grinding and brushing frequency. Management of this condition should include dietary advice, modification of oral habits and advice on tooth brushing techniques.

Dental Students' and Examiner perceptions of an OSCE in the DDS programme in Trinidad

Objective: The School of Dentistry introduced an Objective Structured Clinical Examination (OSCE) in 2014 for Year 3 students in its Doctor of Dental Surgery (DDS) programme, designed to ensure patient care competency. The objective of the study was to determine student and examiner perceptions of thedental OSCE which takes place in Year 3 Semester I. Design and Methodology: All year 3 dental students (n=27) and examiners (n=14) took part in the study. Following ethical approval, a cross-sectional survey method was used. Data were collected on structured questionnaires administered to students and examiners to obtain their perceptions of the OSCE stations which included: History taking, Examination of a patient, Radiographic examination, Basic Life Support and six other specialty stations. Results: Student survey: Fifteen (15) students (55.6%) agreed that the OSCE was fair and 73.1% agreed they were well organized. However, only 55.6% thought there was sufficient time. Nearly 75% felt the OSCE was representative of real clinical scenarios but only 48.1% agreed it was valid in terms of assessing clinical competence. Examiner Survey: Nearly 93% of examiners thought their OSCE station was well organized and that the time allocated was sufficient. One hundred percent (100%) agreed that their OSCE station was fair, a good assessment of the students' competency to begin seeing patients and that the OSCE was a valid form of assessing clinical competence. Conclusion: While less than half of students thought that the OSCE was valid in terms of assessing clinical competence, all of the Examiners thought that it was valid. The discrepancy between student and examiner perceptions needs further investigation.

History and current trends in influenza virus infections with special reference to Sri Lanka.

The World Health Organization (WHO) estimates that approximately one billion people are infected and up to 500,000 people die from influenza each year in the world. Influenza is considered to be the greatest killer of the human populations, due to the 1918 Spanish flu, which killed millions around the world. Despite the effective treatment available against influenza, it still contributes to significant morbidity and mortality. Currently circulating influenza strains in humans include influenza A (H1N1)pdm09, influenza A (H3N2) and influenza B viruses, (B/Victoria and B/Yamagata). Influenza has been prevalent in Sri Lanka from 1969, since then it continued to cause morbidity and mortality in children and adults. The current global influenza surveillance network monitors the global influenza activity through WHO collaborating centres. The Medical Research Institute monitors and diagnoses influenza cases in the country as part of the WHO network laboratories. Vaccinations to high risk groups and antiviral therapy for the successful prevention of influenza have been practiced in Sri Lanka. This review highlights the impact of influenza on public health in Sri Lanka including the historical aspects, current diagnostic practices and prevention approaches in high risk individuals in the country.

Employer and graduate perceptions of the competence of graduates from a dental school in Trinidad

Objective: The objective of this study was to evaluate employers' and graduates' perceptions of the competence of dental graduates from the School of Dentistry, University of the West Indies (UWI). Method: Anonymous questionnaires were sent to employers of the dental graduates in 2013. Similar questionnaires were also completed by graduates of the class of 2011 and 2012. Respondents were asked to rate employees or self assess the UWI School of Dentistry (SoD) curriculum's 23 competency areas and 6 domains of dental practice including: professionalism, assessment of a patient, establishment and maintenance of oral health. Results: Response rates of 48.3%, 100% and 95.7% were obtained from the employers, class of 2011 and class of 2012 respectively. The graduates' self-rated competency means were satisfactory or higher (better) in all competency areas. Employers rated the competency of UWI graduates higher than average in all competency areas except temporomandibular joint/occlusion therapy, orthodontic therapy and dental office administration. Overall, the graduates consistently rated themselves significantly higher than the employers except for periodontal therapy, minor oral surgery, removable prosthodontics and dental office administration. The graduating class of 2011 rated themselves significantly higher than class of 2012 in most (15 out of 23) competency areas. Conclusion: Employers and graduates rated UWI dental graduate competency above average in all areas except orthodontics and dental office administration. UWI dental graduates have a better perception of their competency than do their employers. The School of Dentistry needs to pay particular attention to the areas highlighted and review the curriculum accordingly.

A Retrospective Study To Determine Patients' Satisfaction With Fixed Dental Prostheses Provided During The Period 2008 ­ 2012 at The School of Dentistry In Trinidad

Introduction : The School of Dentistry undertakes the training of dental students, where they provide fixed dental prostheses such as crowns bridges and onlays to patients of the dental polyclinic. The aim of this study was to determine the patient satisfaction with their ixed prostheses and the quantity of remakes at the School of Dentistry polyclinic during the period 2008-2012. Methods : The lab records of ixed prosthetic work during the period 2008-2012 were analyzed. Patients who received treatment during this period were contacted via telephone for a structured interview via a questionnaire. Results : Ninety-six (96) patients were contacted via telephone and 72% of patients were female. Fifty-six (56) crowns and onlays, 22 conventional bridges and 18 resin-retained bridges were provided for patients. Ninety-six (96%) of patients were satisied with the aesthetics (appearance) of their prosthesis immediately after itting and 90.7 % were still satisied with the appearance at the time of interview. 79.2% of prostheses were still in place at the time of interview but patients reported that 18% of crowns failed, 22.7% of conventional bridges and 27.8% of resin-retained bridges had failed. Fifteen (15%) of the ixed prostheses were remade. However, the majority of patients (99 %) were overall satisied with their services at the School of Dentistry in Trinidad. Conclusion : Patients are generally satisied with the ixed prosthetic work delivered at the School of Dentistry polyclinic and highly satisied with the services provided. The amount of remakes whilst small can be reduced with more stringent quality assurance measures.

Dental Erosion and Medical Conditions: An Overview of Aetiology, Diagnosis and Management.

Tooth wear or tooth surface loss is a normal physiological process and occurs throughout life but is considered pathological when the degree of destruction is excessive or the rate of loss is rapid, causing functional, aesthetic or sensitivity problems. The importance of tooth wear as a dental problem has been increasingly recognized. The findings of a study in Trinidad indicate that the prevalence of tooth wear in a Trinidadian population is comparable to the United Kingdom (UK) and, indeed, that the level of moderate and severe wear is in fact nearly twice as high. The aetiology of tooth wear is attributed to four causes: erosion, attrition, abrasion and abfraction. Erosion is generally considered to be the most prevalent cause of tooth wear in the UK and Europe. Acids that cause dental erosion originate mainly from the diet or the stomach and to a lesser extent, the environment. Underlying medical problems can contribute to the progress of tooth wear due to erosion and the patient may not be aware of these conditions. Moderate to severe tooth wear poses a significant clinical challenge to dental practitioners and may result in treatment that is more complex and costly to the patient both in terms of finances and time spent in the dental chair. This paper provides an overview of aetiology and diagnosis of tooth wear, in particular tooth wear due to erosion, so that medical and dental practitioners may recognize tooth wear early, institute preventive measures and manage patients appropriately.

A Cross-sectional Study of Patients' Satisfaction with Dental Care Facilities: A Survey of Adult Treatment at The University of the West Indies, School of Dentistry.

OBJECTIVES: To determine the level of satisfaction with adult dental care at The University of the West Indies (UWI), School of Dentistry, using the Dental Satisfaction Questionnaire (DSQ) developed by Davies and Ware (1982) and to inferentially explore the factors associated with various patients' demographics. METHODS: A cross-sectional study was performed among adult dental patients attending UWI adult dental clinics. Data were collected using a self- administered, structured questionnaire which consisted of 19 questions on three subscales of pain management, quality and access (total). RESULTS: Sixty-nine per cent were female, 40% were between 45 and 64 years old, and 31.3% had excellent self-rated dental health status. A Dental Satisfaction Index (DSI overall) of 76.42% satisfaction was found, with the highest satisfaction subscale for quality (81.17%), while access (72%) was the lowest occurring subscale. The mean DSI was 3.57 for the UWI emergency dental clinic and 3.87 for the polyclinic. The difference between the DSI overall in the emergency clinic compared to the polyclinic was statistically significant (p < 0.05) CONCLUSIONS: There was a high level of overall satisfaction with dental care at the UWI dental school. Self-rated oral health status may be important in patients' satisfaction. Policies and strategies promoting preventive dental advice are likely to improve patients' satisfaction with dental care and may lead to increased satisfaction with dental services.

The use of video-clips as a teaching aide

Introduction: Video-clips of tooth preparations recorded with a digital head-mounted camera replaced live demonstrations midway in a preclinical operative dentistry course. DVDs of the video-clips were made available to the students for home use. Aims: The aim of this study was to determine whether the use of these video-clips had any impact on students' practical examination results and to analyse students' opinions of this new technology and the perceived impact on their learning. Methods: A questionnaire was administered to all students (n = 26) who completed the course, asking their opinions on the video-clips. The results of student practical examinations before the introduction of the camera were compared with those after the video-clips were available and also to the examination outcomes of the previous year's students (ANOVA, P < 0.05). Results: Twenty-one students completed the questionnaire. Sixteen students (76%) preferred the video-clips to the live demonstrations, and 12 students (57%) made and reviewed the DVDs at home. They expressed a preference for the videos to be made available online or as podcasts. Twelve students (57%) felt that one-to-one supervision was more effective developing their competence in tooth preparations when compared to their viewing of the video-clips. There were no statistically significant differences between the practical examination results. Conclusion: In this group of students, video-clips were the preferred method of demonstration of tooth preparations in the preclinical environment. However, students perceived their learning to be facilitated more by one-to-one supervision. The students preferred to have the video-clips made available to them online instead of in the form of a DVD. The introduction of this educational aide did not make a difference in practical examination results.

The use of video-clips as a teaching aide.

INTRODUCTION: Video-clips of tooth preparations recorded with a digital head-mounted camera replaced live demonstrations midway in a preclinical operative dentistry course. DVDs of the video-clips were made available to the students for home use. AIMS: The aim of this study was to determine whether the use of these video-clips had any impact on students' practical examination results and to analyse students' opinions of this new technology and the perceived impact on their learning. METHODS: A questionnaire was administered to all students (n = 26) who completed the course, asking their opinions on the video-clips. The results of student practical examinations before the introduction of the camera were compared with those after the video-clips were available and also to the examination outcomes of the previous year's students (ANOVA, P < 0.05). RESULTS: Twenty-one students completed the questionnaire. Sixteen students (76%) preferred the video-clips to the live demonstrations, and 12 students (57%) made and reviewed the DVDs at home. They expressed a preference for the videos to be made available online or as podcasts. Twelve students (57%) felt that one-to-one supervision was more effective developing their competence in tooth preparations when compared to their viewing of the video-clips. There were no statistically significant differences between the practical examination results. CONCLUSION: In this group of students, video-clips were the preferred method of demonstration of tooth preparations in the preclinical environment. However, students perceived their learning to be facilitated more by one-to-one supervision. The students preferred to have the video-clips made available to them online instead of in the form of a DVD. The introduction of this educational aide did not make a difference in practical examination results.

Oral and dental conditions presenting to medical practitioners in Trinidad and Tobago.

OBJECTIVES: To describe the type and frequency of oral and dental conditions presenting to medical practitioners in Trinidad and Tobago, type of management, and interest in continuing education in oral diseases. METHOD: Cross sectional survey of registered medical practitioners in Trinidad. 20-item self-reported questionnaire. RESULTS: 103 medical practitioners participated in the study (response rate 69%). Mean age 33 years. Mean years since qualifying was 8 years and 72% worked mainly in hospital service or private practice (19%); 67% had seen patients with a dental problems, with 69% of those at least as frequently as once a month. Most frequently seen problems were dental abscess (72.5%) and toothache (59.4%). In the case of dental abscess and oral mucosal infection 31.9% and 63.8% respectively, diagnosed and treated before referring. 84% cent expressed interest in receiving continuing education in oral diseases. CONCLUSIONS: In the context of access to oral care in Trinidad and Tobago, medical practitioners appear to be important providers and may benefit from further training in the diagnosis and management of oral diseases.

Oral and dental conditions presenting to medical practitioners in Trinidad and Tobago.

OBJECTIVES: To describe the type and frequency of oral and dental conditions presenting to medical practitioners in Trinidad and Tobago, type of management, and interest in continuing education in oral diseases. METHOD: Cross sectional survey of registered medical practitioners in Trinidad. 20-item self-reported questionnaire. RESULTS: 103 medical practitioners participated in the study (response rate 69 per cent). Mean age 33 years. Mean years since qualifying was 8 years and 72 per cent worked mainly in hospital service or private practice (19 per cent); 67 per cent had seen patients with a dental problems, with 69% of those at least as frequently as once a month. Most frequently seen problems were dental abscess (72.5 per cent) and toothache (59.4 per cent). In the case of dental abscess and oral mucosal infection 31.9 per cent and 63.8 per cent respectively, diagnosed and treated before referring. 84 per cent expressed interest in receiving continuing education in oral diseases. CONCLUSIONS: In the context of access to oral care in Trinidad and Tobago, medical practitioners appear to be important providers and may benefit from further training in the diagnosis and management of oral diseases.

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad.

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2 per cent had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.

The prevalence and severity of non-carious cervical lesions in a group of patients attending a university hospital in Trinidad.

Non-carious cervical lesions (NCCLs) are often encountered in clinical practice and their aetiology attributed to toothbrush abrasion, erosion and tooth flexure. This paper aims to determine the prevalence and severity of NCCLs in a sample of patients attending a university clinic in Trinidad and to investigate the relationship with medical and dental histories, oral hygiene practices, dietary habits and occlusion. Data were collected via a questionnaire and clinical examination. Odds ratios were used to determine the association of the presence of lesions and the factors examined. One hundred and fifty-six patients with a mean age of 40.6 years were examined of whom 62.2% had one or more NCCLs. Forty five per cent of the lesions were sensitive to compressed air. Younger age groups had a significantly lower correlation with the presence of NCCLs than older age groups. Other significant factors included patients who reported heartburn, gastric reflux, headaches, bruxism, sensitive teeth and swimming or had a history of broken restorations in the last year. There was also significant correlation of NCCLs in patients who brushed more than once a day or used a medium or hard toothbrush. Patients with vegetarian diets and those who reported consuming citrus fruits, soft drinks, alcohol, yoghurt and vitamin C drinks were associated with the presence of lesions. Significant associations were also found in patients with group function, faceting, clicking joints or those who wore occlusal splints.

Tooth surface loss in adult subjects attending a university dental clinic in Trinidad.

OBJECTIVES: To determine the prevalence of tooth surface loss (TSL) in a sample of subjects attending a university dental clinic in Trinidad and to investigate the relationship to tooth brushing, medical history, parafunction and dietary habits. DESIGN: Tooth surface loss was measured clinically by the index used in the 1998 UK, Adult Dental Health Survey. SETTING: Trinidad, West Indies. PARTICIPANTS: Convenience sample of adult subjects attending The University of the West Indies Dental School Polyclinic, Mount Hope. METHODS: A questionnaire was administered and tooth surface loss measured clinically. MAIN OUTCOME MEASURES: mild, moderate and severe tooth surface loss. RESULTS: 155 subjects were examined (mean age 40.6 years) of whom 72% had some degree of TSL with the majority (52%), exhibiting mild, 16% with moderate and 4% with severe TSL. There were associations found between TSL and age (OR=3.14), reflux (OR=1.37), parafunction (OR=1.06), weekly consumption of citrus fruits (OR=1.31) and soft drinks (OR=1.78), daily consumption of alcohol (OR=1.40) and a vegetarian diet (OR=2.79). CONCLUSIONS: Tooth surface loss in this Trinidadian population group appears to be common. Data supports an association between TSL and age, reflux parafunction and certain dietary patterns.

An in vitro evaluation of shear bond strengths of glass ionomer/amalgam combinations

Purpose: The purpose of this study was to assess the shear bond strength of amalgam when bonded to dentine with various cements. Materials and Methods: Eighty human molars were divided into five groups and ground dentine surfaces treated, with one of five cements (Fuji I, Vitrebond, Rely X, Fuji II and Panavia F). Spherical amalgam (Tytin) was condensed onto the unset cement and shear bond strengths were measured after one week. Results: The mean shear bond strength of Panavia F (25.3 MPa) was significantly higher compared with Fuji I (16.8 MPa), Fuji II (10.3 MPa) and Vitrebond (5.1 MPa) however there was no significant difference with Rely X (19.0 MPa). Conclusion: The combination of a resin modified glass ionomer luting cement with a spherical alloy may enhance bonding of amalgam to dentine.

Management of teeth requiring root canal treatment and views on continuing professional education in endodontics by dental practitioners in Trinidad and Tobago [abstract]

Many of the new materials and techniques used in endodontics (root canal treatment) require considerable practice to master and many require continuing education courses to allow formal instruction. Nothing is known regarding techniques employed and views on continuing professional education (CPE) in endodotics by dentists in Trinidad and Tobago. With the shift toward evidence-based dentistry and rising patient expectation of quality oral health care, a survey was conducted to describe these issues. A self-administered postal questionnaire was sent to all registered dentists in Trinidad and Tobago. Seventy dentists responded after two mailings. Most respondents worked primarily in private practice (85.5 percent). Years since qualification ranged from 2 to 45 years and 54.3 percent were qualified for more than 10 years. Most frequent treatment of an acute dental abcess involved opening, preparing the canal(s), dressing and prescribing antibiotics (40 percent). Forty-one respondents (58.6 percent) ocassionally completed root canal treatment in a single visit. Isolation of the tooth for molar root treatment always caused difficulty for thirty-five respondents (50 percent) and rubber dam isolation was used routinely by only nine respondents (12.9 percent). Most respondents either filed (20 percent) or reamed (18 .6 percent) for canal preparation usually using K files. Thirty-three respondents (47 percent) used sodium hypochlorite to irrigate the tooth and thirty-one (44.3 percent) used cold lateral condensation of gutta percha to obturate. Thirty-four respondents (48.6 percent) subscribed to professional journals and sixty-seven (95.7 percent) had attended some form of Continuing Professional Education. Sixty-seven (95.7 percent) of respondents would attend CPE in endodontics if available in Trinidad and Tobago, with most (72.9 percent) preferring a lecture/seminar format addressing problem-solving and new techniques. Respondents to this survey showed use of a wide range of techniques and materials but still expressed considerable interest in developing their skills in endodontics through formal CPE. (AU)

Sealing capacity in vitro of thermoplasticized gutta-percha with a solid core endodontic filling technique.

This study assessed the sealing capacity of two endodontic gutta-percha filling techniques. Thirty-four single-rooted fully developed teeth were endodontically accessed, instrumented and randomly divided into two experimental groups (n = 12) and two control groups (n = 5). In Group A, root canals were obturated using a solid core thermoplastic technique (Densfil), in Group B and Group C (negative control) canals were obturated with laterally condensed gutta-percha, and in Group D (positive control) canals were left unobturated. AH-26 was used as the sealer. Two days later, the teeth were conventionally prepared for testing apical and coronal leakage, immersed in india ink for 5 days and subsequently cleared. The linear coronal and apical extent of dye penetration was measured under a light dissecting microscope. The mean apical leakage for Group A was 1.39 mm, and for Group B 2.76 mm, whereas the mean coronal leakage for Group A was 2.87 mm, and for Group B 4.03 mm. The differences between the groups were not statistically significant (P > 0.05).