The association between edentulism and progress of multimorbidity over 12 years among older American adults.

OBJECTIVES: To examine the relationship between edentulism and the progress of multimorbidity, and the role of nutritional intake and behaviours among older Americans. METHODS: We used 7 waves (2006-2018) of the Health and Retirement Study, a longitudinal survey of older Americans (number included in analysis 2,224). Edentulism was assessed in 2006 and 2012. Multimorbidity was indicated by 5 self-reported conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioural factors were smoking, excessive alcohol consumption, physical activity, and body mass index. Nutritional intake was calculated by summing 10 nutrients (Protein, Vitamins C, D, B12, E, Calcium, Zinc, Polyunsaturated fatty acids, Folate and ß- carotene). Multilevel models for analysis of longitudinal data were used to assess the association between change in repeated measures of multimorbidity (between 2006 and 2018) and edentulism (2006) adjusting for nutritional intake, behavioural and socioeconomic factors. RESULTS: Participants who were edentate in 2006 and 2012 had higher rate-ratios (RR) for change in multimorbidity between 2006 to 2018 (RR: 1.29 and 1.28, respectively). After adjusting for socioeconomic factors, total nutrients and behavioural factors, these RR attenuated to 1.12 (95%CI: 1.06, 1.18) and 1.10 (95%CI: 1.05, 1.16), respectively. Total nutrition was negatively associated with progress of multimorbidity, but after adjusting for socioeconomic and behavioural factors the association became insignificant. Total nutrients rates in 2013 were significantly lower among those who were edentate in 2006 and 2012. CONCLUSION: There was a longitudinal association between edentulism and progress of multimorbidity. The relationship appeared to be mediated be behaviours and nutrition.

Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups.

INTRODUCTION: Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS: A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS: The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION: These results are positive, and the scales now need to be validated in the field. CONCLUSIONS: It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.

Development of quality measurement instruments for root canal treatment.

AIM: To devise measurement instruments for 'quality' of root canal treatment to assess training and outcome of general dental practitioners working within primary care settings. METHOD: Scoring systems relating to quality of root canal treatment were developed using expert consensus and published literature. Domains scored included the Treatment Process, Quality of the Obturation, Clinical Healing, Radiographic Healing and Tooth Complexity. Scoring systems were applied to 10 clinical cases treated by each dentist at the beginning and 10 cases treated at the end of their clinical training and 135 cases treated after completion of training. The dentists recorded the treatment process and clinical healing in clinical logs. Two examiners independently scored the radiographs after undertaking calibration and training. Inter- and intra-examiner reliability of scoring radiographic outcomes was tested using Cohen's Kappa statistics. RESULTS: An instrument was created with four domains to assess quality (two for process and two for outcome of root canal treatment), and a measure of case complexity. Domains of treatment process (n = 240 teeth), outcome (n = 32 teeth) and complexity (n = 215 teeth) were scored using radiographs. The Kappa scores for intra-examiner reliability between 0.22 and 1, whilst inter-examiner reliability ranged between 0.18 and 0.99. CONCLUSION: Evidence-based scores for assessment of the quality (process and outcome) and complexity (structure) of root canal treatment were devised. They were reliable, provided that clinicians were trained in record keeping and examiners have in depth training and calibration in the use of the instruments.

Effectiveness of a web-based child protection training programme designed for dental practitioners in Saudi Arabia: a pre- and post-test study.

AIM: Safeguarding children is an integral part of dental training and practice. The purpose of this research was to evaluate a web-based training program in child protection on dental practitioners' knowledge and practice in Saudi Arabia. In addition, participants' views of the course were also assessed. METHOD: Pre-, immediately post-training, and one month post-training knowledge and self reported behaviour were assessed following completion of an online training course in child protection by 82 dental practitioners working in Saudi Arabia. RESULTS: Eighty-two participants completed the whole training package and 62 completed the one month post-training survey. A significant increase in knowledge was found immediately after taking part in the child protection training program in comparison to baseline knowledge (P < 0.001). The course was highly rated by those who completed it. At one month following the training program, 21% have or intend to adopt a child protection policy in their practice, 29% identified a staff member to lead on child protection since completing the program, almost all participants have been aware of child abuse and neglect (CAN) signs in their daily practice and 27.4% have made a report of a suspected case of CAN in the last month since the training. CONCLUSION: The web-based training program in child protection was appraised positively and was effective in increasing knowledge and changing attitudes towards safeguarding children.

Interceptive orthodontic treatment in bullied adolescents and its impact on self-esteem and oral-health-related quality of life.

The aim of this follow-up study was to measure the self-reported frequency and severity of bullying in orthodontic patients previously identified as being bullied, who have commenced interceptive orthodontic treatment, and to investigate the effect on an individual's self-esteem and oral-health-related quality of life (OHRQoL). Forty-three adolescents previously identified as being bullied due to the presence of a malocclusion were invited to take part in a follow-up study following commencement of orthodontic treatment at three UK Hospitals. Validated questionnaires were used to assess the self-reported frequency and severity of bullying, self-esteem and OHRQoL. The participation rate at follow-up was 63 per cent. Following commencement of orthodontic treatment, 21 (78 per cent) participants reported they were currently no longer being bullied due to the presence of their malocclusion. In comparison to their pre-treatment scores, participants reported fewer functional limitations (P = 0.013), decreased emotional (P < 0.001) and social impact (P < 0.001), and improved overall oral health (P = 0.03) and OHRQoL (P = 0.002). In addition, an improvement in functional limitations (P = 0.021), emotional (P = 0.008), social impact (P = 0.008) and OHRQoL (P = 0.02) was reported by participants who were no longer being bullied in comparison to those who continued to report bullying. There appears to be no effect on an individual's self-esteem. Orthodontic treatment may have a positive effect on adolescents experiencing bullying related to their malocclusion and their OHRQoL.

Great expectations: what do patients expect and how can expectations be managed?

Patients' expectations of their treatment are a key determinant in their satisfaction with treatment. Expectations may encompass not only notions of the outcome of treatment, but also the process of treatment. This article explores the processes by which expectations are formed, differences in expectations across patient groups, and the psychopathology of individuals with unrealistic expectations of treatment manifest in body dysmorphic disorder.

Sense of coherence and four-year caries incidence in Finnish adults.

This study assesses whether sense of coherence (SOC) predicts incidence of tooth decay over 4 years and the role of dental behaviours in explaining the effect of SOC on incidence of tooth decay. Data from 994 adults who participated in both the Health 2000 survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed for this study. At baseline, participants provided information on demographic characteristics, education level, the SOC scale and dental behaviours (tooth brushing frequency, dental attendance and sugar intake frequency). The 4-year incidence of tooth decay was calculated using data from baseline and follow-up clinical oral examinations. Baseline SOC was significantly related to 4-year incidence of tooth decay after adjustment for demographic factors and education (relative risk: 0.79, 95% CI: 0.63-0.98). This effect was fully attenuated after further adjustment for the three dental behaviours. Tooth brushing frequency and dental attendance were the only dental behaviours significantly related to incidence of tooth decay. This prospective study suggests that SOC predicts incidence of tooth decay and that dental behaviours may help explaining why adults with strong SOC have lower risk of developing tooth decay than those with weak SOC.

Dentists' Perceptions of Personal Infection Control Measurements in Response to COVID-19.

OBJECTIVE: To explore through focus groups (FGs) the perceptions of dental practitioners (DPs) from different countries of the challenges of implementing coronavirus disease 2019 (COVID-19) related biosafety measures, especially personal protection equipment (PPE), during the COVID-19 pandemic period. METHODS: DPs from Colombia, Germany, the United Kingdom, and the United States were invited to participate in country-based FGs. These were facilitated by an experienced moderator who explored the factors that guided the implementation of COVID-19 related biosafety measures and PPE use. Data were analyzed through thematic analysis on the basis of categories defined by the researchers deductively and inductively. RESULTS: A total of 25 DPs participated in 3 FGs (Colombia:n = 8; United Kingdom: n = 7; United States: n = 9) and 1 in an in-depth interview (Germany). DPs described using several processes to judge which guidance document to adopt and which aspects of the guidance were important in their practice. These included making judgments concerning the views of any indemnity organization to which the DPs were responsible, the staff's views in the practice, and the views of patients. In the absence of a single overarching guidance document, DPs filtered the available information through several considerations to find a level of PPE that they deemed "implementable" in local practice. CONCLUSIONS: The findings suggest that the implementation of evidence-based practice is subject to modification through a lens of what is "feasible" in practice. KNOWLEDGE TRANSFER STATEMENT: Clinicians, educators, and policy makers can use the results of this study to understand the process through which guidance is transformed into implementable patient care pathways in the dental practice.

Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health.

The behavioral and social sciences are central to understanding and addressing oral and craniofacial health, diseases, and conditions. With both basic and applied approaches, behavioral and social sciences are relevant to every discipline in dentistry and all dental, oral, and craniofacial sciences, as well as oral health promotion programs and health care delivery. Key to understanding multilevel, interacting influences on oral health behavior and outcomes, the behavioral and social sciences focus on individuals, families, groups, cultures, systems, societies, regions, and nations. Uniquely positioned to highlight the importance of racial, cultural, and other equity in oral health, the behavioral and social sciences necessitate a focus on both individuals and groups, societal reactions to them related to power, and environmental and other contextual factors. Presented here is a consensus statement that was produced through an iterative feedback process. The statement reflects the current state of knowledge in the behavioral and social oral health sciences and identifies future directions for the field, focusing on 4 key areas: behavioral and social theories and mechanisms related to oral health, use of multiple and novel methodologies in social and behavioral research and practice related to oral health, development and testing of behavioral and social interventions to promote oral health, and dissemination and implementation research for oral health. This statement was endorsed by over 400 individuals and groups from around the world and representing numerous disciplines in oral health and the behavioral and social sciences. Having reached consensus, action is needed to advance and further integrate and translate behavioral and social sciences into oral health research, oral health promotion and health care, and the training of those working to ensure oral health for all.

Social perceptions of adults wearing orthodontic appliances: a cross-sectional study.

This study ascertained the influence of orthodontic appliances on subjective ratings for social competence (SC), intellectual ability (IA), psychological adjustment (PA), and attractiveness in young adult orthodontic patients. A cross-sectional analytical questionnaire study was conducted with 130 undergraduates from the UK. Each participant was asked to look at a single, randomly assigned colour photograph of a young adult female and then asked to make judgements concerning her personal characteristics. Five modified photographs of the same young adult female were used: (1) no appliance, (2) stainless steel fixed orthodontic appliance, (3) ceramic fixed orthodontic appliance, (4) gold fixed orthodontic appliance, and (5) clear colourless aligner. Likert scales with higher scores indicating more positive ratings were used. The results were analysed using chi-square test, one-way univariate analysis of variance, and post hoc Tukey-B and Kruskal-Wallis tests. The results showed that greater perceived IA was associated with the appearance of no appliance (mean values: 7.56) rather than steel (6.67) or ceramic appliances (6.65) but similar to the gold (7.35) and aligner (7.08) appliances. No significant differences between the different orthodontic appliance appearances were found for SC and PA. A trend existed where the no appliance image (resembling a lingual appliance) or clear aligner was considered more attractive than the visible buccal fixed appliances. In the absence of other information, the judgements an individual young adult makes concerning the personal characteristics of a young adult are influenced by dental appearance and orthodontic appliance design. This may influence orthodontic appliance choice.

The impact of tooth colour on the perceptions of age and social judgements.

OBJECTIVE: Psychological research has established that the presence of dental anomalies negatively impact social judgements. This study sought to determine the effects of tooth colour on the subjective ratings of social judgements in a group of Caucasian adults. METHODS: A cross sectional experimental analogue design comprised fifty Caucasian adults: 25 women and 25 men. A total of 54 digitally modified photographs of Caucasian males and females (darkened, natural, whitened teeth) were evaluated. All participants evaluated each of the images on 12 characteristics: popularity, friendliness, social life, success, graduation, happiness, intelligence, perceived age, introversion/extraversion, self-confidence, attractiveness and satisfaction with the tooth shade. Analysis of variance (ANOVA) was used to compare ratings. RESULTS: Participants associated darkened teeth with poorer subjective ratings, with the highest ratings been given to whitened teeth, and natural teeth being intermediate. These trends were similar across all participant age groups and gender. Further, the gender and age groups of the images had a significant effect on the appraisals. Faces of younger models received higher ratings than the faces of older models and female images were rated higher than the males. CONCLUSION: In the absence of other information, tooth colour exerts an influence upon the appraisals made in social situations. It appears that whitened tooth appearance is preferred to natural tooth appearance, irrespective of age and gender of the judge. The faces with more whitened dentition are perceived to be younger across all age groups and gender of the judges. Participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. CLINICAL SIGNIFICANCE STATEMENT: This research used standardised tooth colour as a basis to investigate perceived age and social functioning. As clinicians face daily challenges to achieve patient satisfaction with respect to dental aesthetics, standardizing the colour may enhance the patients' satisfaction. Further, participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. The whitened dentition may impair the psychological well-being of the individuals and is probably a reason for the increasing demand for cosmetic dental procedures. These results may be instructive for the development of a psycho-educational intervention to prevent any unrealistic expectations.

The impact of visible dental decay on social judgements: comparison of the effects of location and extent of lesion.

BACKGROUND: Previous research has established that people can make social judgements about someone else based on the condition of that person's teeth. The characteristics of visible tooth decay, with respect to the effect on such social judgements, have not, however, been subject to extensive investigation. This study sought to determine whether the position of visible decay and/or the extent of the lesion are determining factors in such social judgements of each other. METHOD: In a between subjects design, 100 young people were randomly divided into 4 groups of 25 and each group shown a differently computer-modified photograph of the same person. Extent and location of the lesion were varied systematically. Participants were asked to rate the person in the photograph with respect to intellectual ability, social competence and psychological adjustment. The scores from those questions were analysed with one way analysis of variance (ANOVA) then Tukey's HSD where ANOVA revealed significant differences. RESULTS: The data confirmed previous studies that have shown that poor dental condition is highly correlated with perceived poor social performance and intellectual ability. Further, the data showed that with respect to the constructs of intellectual ability, extraversion and care for one's personal appearance, a more central position of caries is more predictive of poor social judgements than just the presence of visible decay, or even twice the amount of decay. We discuss the possible evolutionary and ontological reasons for making social judgements that are influenced by a person's dental health as well as considering the implications of our findings for dentists.

A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries.

OBJECTIVE: To determine the difference in level of dental caries in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG or use alternatives such as lozenges, candies, rinses, tablets, and other nonchewing controls. METHODS: Systematic review of published literature. RESULTS: Twelve studies of interventions of SFG for dental caries outcomes were included. SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28% (95% CI, 7% to 48%). Including the 8 trials that used xylitol gum only as the basis of the intervention, the PF was 33% (95% CI, 4% to 61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included. CONCLUSION: The findings of this review provide tentative evidence that chewing SFG reduces caries increment in comparison to nonchewing controls. However, there is a considerable degree of variability in the effect and the trials included were generally of moderate quality. There is a need for future research to explore the acceptability and feasibility of the use of SFG as a public health intervention (PROSPERO 2018 CRD42018094676). KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians when deciding how best to implement dental caries prevention regimes for their patients. With consideration of cost and patient preference, this information could help to develop national policy directives on caries prevention and dictate the direction of future clinical research.

Self-reported occupational health of general dental practitioners.

BACKGROUND: Limited information is available regarding the occupational health status of dentists (particularly in New Zealand), although previous research suggests that stress, hand dermatoses and musculoskeletal symptoms are common. AIMS: To determine the occupational health status of New Zealand dentists. METHODS: A nationwide postal survey of a representative sample of 750 dentists. RESULTS: There was a response rate of 77%. Most dentists (71%) reported their general health as very good or excellent; 43% rated their physical fitness as excellent or very good and 64% were happy and interested in life. Workplace bullying had been experienced by 19% and was higher for female and employee dentists and 29% had experienced a violent or abusive incident at work. Almost half of the sample (47%) had experienced at least one dermatitis-type condition in the previous 12 months. The most commonly reported sites for musculoskeletal problems experienced in the previous year were the neck (59%), lower back (57%) and shoulders (45%). Women had a higher prevalence of several occupational health problems, but were more satisfied with their overall health than male dentists. CONCLUSIONS: The majority of dentists had good general health, but physical fitness levels were not ideal. The prevalence of hand dermatoses and musculoskeletal problems are high and impact significantly on dentists' daily lives. Interventions such as reducing weight and training in optimal working methods to reduce musculoskeletal problems and injuries (such as eye or needlestick incidents) might improve the health of this workforce but further research is required.

Music may reduce anxiety during invasive procedures in adolescents and adults.

DESIGN: A block randomised controlled trial was conducted. INTERVENTION: Patients in the music (test) group listened to selected sedative music using headphones throughout the root canal treatment procedure. The control group subjects wore headphones but without the music. OUTCOME MEASURE: Anxiety was measured before the study and at the end of the treatment procedure. Patients' heart rate, blood pressure and finger temperature were measured before the study and every 10 min until the end of the root canal treatment procedure. RESULTS: The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender. The subjects in the music group, however, showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group. The effect size for state anxiety and finger temperature was 0.34 and 0.14, respectively. CONCLUSIONS: Relaxing music administered through headphones to subjects during root canal treatment decreased the procedure-related anxiety of the patients and significantly increased finger temperature, but does not significantly affect blood pressure and heart rate over the procedure.

Interventions for the management of submucous cleft palate.

BACKGROUND: Submucous cleft palate (SMCP) is a common congenital malformation of the soft palate which may present as velopharyngeal insufficiency (VPI), which can affect the quality and intelligibility of speech. Surgical techniques, which can be used to reconstruct these structural or anatomical defects and to correct velopharyngeal insufficiency, include palatal repair and procedures that rearrange the muscle attachments of the soft palate. OBJECTIVES: To provide reliable evidence regarding the effectiveness of surgical interventions to treat velopharyngeal insufficiency and improve speech in patients with submucous cleft palate. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register (to 21st December 2006); Cochrane Developmental, Psychosocial and Learning Problems Group Trials Register (on 12th March 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (from 1966 to 21st December 2006); EMBASE (from 1980 to 21st December 2006); and CINAHL, ERIC, PsycINFO (on 7th March 2007). SELECTION CRITERIA: Randomised controlled trials comparing surgical interventions to correct velopharyngeal insufficiency in submucous cleft palate. DATA COLLECTION AND ANALYSIS: Limited data from one included trial precluded pooling of data, and only a descriptive summary is presented. MAIN RESULTS: This review included one trial, involving 72 participants aged 4 to 7 years with submucous cleft palate associated velopharyngeal insufficiency, which compared minimal incision palatopharyngoplasty (MIPP) to MIPP with additional velopharyngeal surgery, either pharyngeal flap (32) or sphincter pharyngoplasty (3). The trial provided no information about post-operative speech assessment, very limited data on any instrumental assessments and there were no reports of obstructive sleep apnoea or other adverse effects after the interventions. Complete closure occurred in 32 (86%) of the participants in the MIPP group and in 31 (89%) in the additional treatment group, P > 0.05. After eliminating the nine patients with residual velopharyngeal insufficiency, the post-operative gap size during closure was 7.4 +/-3.2% in the MIPP group and 8 +/-4.1% in the additional intervention group (P > 0.5). AUTHORS' CONCLUSIONS: The trial provided some weak and unreliable evidence that there was no significant difference in the effectiveness of minimal incision palatopharyngoplasty versus the same procedure performed simultaneously with an individually tailored pharyngeal flap or sphincter pharyngoplasty for correcting velopharyngeal insufficiency associated with submucous cleft palate.

Job stressors of New Zealand dentists and their coping strategies.

BACKGROUND: Dentistry is understood to be a stressful profession. Although there has been recent research about stress and dentistry in the UK and the Netherlands, little is known about the job stressors and coping strategies of New Zealand dentists. AIM: To investigate job stressors and coping strategies among New Zealand dentists. METHODS: A nationwide postal survey of a representative sample of 700 dentists. RESULTS: The response rate was 65%. The most commonly reported stressors were treating difficult children (52%), constant time pressure (48%) and maintaining high levels of concentration (43%). The strategies most utilized for managing work-related stress included interactions with people (78%), sports (64%) and forgetting about work (59%). Dentists who had graduated overseas reported more sources of stress than New Zealand graduates. There were differences in the strategies used by male and female practitioners to manage stress. CONCLUSIONS: There is considerable variation in the number of stressors experienced by dentists. Overseas-qualified dentists appear to be under more stress than New Zealand-trained dentists and may need greater professional support. Dentists should be encouraged to make greater use of active coping strategies.

Patients' Acceptability of Computer-Based Information on Hypodontia: A Randomized Controlled Trial.

OBJECTIVES: To compare patients' acceptability of a hypodontia-specific interactive computer-based education material (ICB-EM) versus a British Orthodontic Society (BOS) hypodontia leaflet. TRIAL DESIGN: Two-arm parallel randomized controlled trial, 1:1 allocation ratio. METHODS: The study was conducted at a specialized secondary care facility in the Greater London area. Ninety-six new hypodontia patients aged 14 y and older were randomly assigned to the control group ( n = 49) receiving the BOS leaflet or the intervention group ( n = 47) receiving the ICB-EM. The main outcome measure was patients' evaluation of the intervention measured by the treatment evaluation inventory. RESULTS: The analyzed sample comprised 76 participants: control group ( n = 38) and intervention group ( n = 38). The mean age of the sample was 19 y (SD = 7.24) and 20.3 y (SD = 6.9) for the control and intervention group, respectively. The intervention group was significantly more satisfied with the ICB-EM than individuals who received the BOS leaflet ( t = -3.53, P = 0.001). CONCLUSION: Patients preferred the computer-based information. KNOWLEDGE TRANSFER STATEMENT: Patients attending dental care in the 21st century are adept in the use of computerised facilities for obtaining information. The results of the study will provide valuable evidence for clinicians on the level of acceptability of the patients toward interactive computer based health education as opposed to traditional paper leaflets.

Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning.

Objectives: To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs. Methods: Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training. Participant: Dentists working in and patients treated in primary dental care in London. Intervention: Twenty-four-month training in endodontics. Comparison: Dentists enrolled in the training at different time points. Outcome: Measuring outcome of endodontic treatment. Results: Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1­36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up. Conclusions: Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.

Resorbable versus titanium plates for orthognathic surgery.

BACKGROUND: Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. OBJECTIVES: To compare the effectiveness of bioresorbable fixation systems with titanium systems used during orthognathic surgery. SEARCH STRATEGY: We searched the following databases: Cochrane Oral Health Group Trials Register (to 26th January 2006); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE (without filter) (from 1966 to 26th January 2006); and EMBASE (without filter) (from 1980 to 26th January 2006). SELECTION CRITERIA: Randomised controlled trials comparing resorbable versus titanium fixation systems used for orthognathic surgery. DATA COLLECTION AND ANALYSIS: Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented. MAIN RESULTS: This review included two trials, involving 103 participants, one compared titanium with resorbable plates and screws and the other titanium with resorbable screws, both provided very limited data for the primary outcomes of this review. All patients in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates P = 0.83 (published as P = 0.67). AUTHORS' CONCLUSIONS: This review provides some evidence to show that there is no statistically significant difference in postoperative discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials in orthognathic surgery.