The teaching of fixed partial dentures in undergraduate dental schools in Ireland and the United Kingdom.

All areas of the practice of dentistry are evolving at a considerable pace. One area in particular which has seen a rapid revolution is the oral rehabilitation of partially dentate adults. The aim of this study was to describe the contemporary teaching of fixed partial dentures (FPDs) in dental schools in Ireland and the United Kingdom. An online questionnaire which sought information in relation to the current teaching of FPDs was developed and distributed to 15 Irish and UK dental schools with undergraduate teaching programmes in Spring 2009. Responses were received from 12 schools (response rate=80%). All schools offer teaching programmes in relation to FPDs. The number of hours devoted to pre-clinical/phantom head teaching of FPDs ranged from 3 to 42h (mean: 16h). The staff/student ratio for pre-clinical teaching courses in FPDs ranged from 1:6 to 1:18 (mode: 1:12). Cantilever resin-retained FPDs were the most popular type of FPD provided clinically (average=0·83 per school; range=1-2). Five schools (42%) report that they have requirements (e.g. targets, quotas, competencies) which students must complete prior to graduation in relation to FPDs. Fixed partial dentures form an important part of the undergraduate teaching programme in UK and Irish dental schools. While this teaching is subjected to contemporary pressures such as lack of curriculum time and a lack of available clinical facilities and teachers, there is evidence that teaching programmes in this area are evolving and are sensitive to current clinical practice trends and evidence-based practice.

Crown and bridge disassembly--when, why and how.

Crown and bridgework has a finite life span and fails for a number of reasons. Removal is often by destructive means. There are a number of clinical circumstances, however, in which a conservative disassembly would aid the practitioner in completing restorative/endodontic procedures. The aims of this paper are to provide a classification for crown and bridge removal systems; describe how a number of such systems work; and when and why they might be considered.

Does the gender of the subject affect perceived smile aesthetics when varying the dimensions of maxillary lateral incisors?

Objective: To assess whether subject gender influences aesthetic opinion when altering the width of maxillary lateral incisors. Method: Photographs of a male and a female smile, displaying only the lips and teeth, were digitally altered to produce images where the maxillary lateral incisor was proportioned 52%, 57%, 62%, 67%, 72% and 77% in relation to the width of the maxillary central incisor. The image was then made symmetrical. One hundred participants (50 male and 50 female) were asked to rank each set of photographs from 'most' to 'least attractive'. Result: The 57% lateral incisor was considered the 'most attractive' with the 77% lateral incisor the 'least attractive' however no statistically significant difference existed with relation to subject or rater gender. Conclusion: Neither the 'golden proportion' nor the 'Recurrent Aesthetic Dental' ('RED') proportion was deemed the most attractive. As subject gender did not have a significant effect, dentists should work to create aesthetic results on an individual basis, operating within a so-called 'golden range'.

A human lymphoma cell line with multiple immunoglobulin rearrangements.

The development of a cell culture system efficient in the establishment of lymphoma cell lines has made it possible to dissect basic biological and molecular aspects of lymphoma cells. We have established a lymphoma cell line from a patient with B cell lymphoma. The cell line has a complex karyotype with translocations involving bands 8q24, 14q32, and 18q21. Molecular analysis revealed that the Myc gene was rearranged; we were unable to demonstrate rearrangement of the Bcl-2 gene. Evaluation of the structure of the heavy chain Ig genes revealed that the cell line carried the same rearrangements as the cells from which the cell line was derived. The pattern of rearrangement, however, was unusual in that there were at least four rearranged bands when DNA cut with HindIII was probed with a fragment of the heavy chain joining region. To further characterize the cell line, subclones were derived. Individual subclones had the same pattern of rearrangement as the parent cell line. The results of these studies provide evidence that multiple rearranged Ig genes may be present in a single clone of cells.

Attitudes of general dental practitioners in the UK to the use of composite materials in posterior teeth.

OBJECTIVE: To determine the opinions and current methods used in placing posterior composite restorations by general dental practitioners. SETTING: The study was completed by general dental practitioners randomly selected from across the UK. METHOD: A questionnaire was devised to gain this information. It was sent to 500 UK dentists chosen at random from the general dental register, with an explanatory letter and reply-paid envelope. RESULTS: Two hundred and sixty-seven replies were received. Sixty-one percent of dentists felt amalgam use had decreased over the last five years, 75% felt posterior composite use had increased. Regarding choice of posterior material, almost all cited clinical indication as the most influential factor while patient's aesthetic demands (89%),wish for a certain material (78%) and the dentist's confidence using a certain restorative material (76%) were contributing factors. Regarding the techniques used, contemporary techniques were employed although there was confusion regarding the need for rubber dam and the most appropriate method of lining the cavity. A case scenario of a pregnant patient who required treatment found that 66% of respondents would place a restoration other than a temporary dressing, with 16% placing an amalgam restoration. CONCLUSIONS: The majority of dentists surveyed place load bearing posterior composite restorations regularly. Their choice of restorative material is influenced by clinical indications and the patient's aesthetic demands. The techniques used were appropriate, although there was confusion around the need for rubber dam and the most appropriate method to line the cavity. There was also confusion in relation to the most appropriate materials for use in pregnancy.

Implant retention systems for implant-retained overdentures.

Implant retained overdentures are being increasingly utilised in both general and specialist practice to rehabilitate patients with missing teeth, particularly those that are edentate. This article aims to inform the reader of a variety of retention systems that are available to retain an implant overdenture and to understand how these systems work, their advantages and disadvantages and to outline some of the clinical and treatment planning considerations involved in selecting the most appropriate retention system for patients.

Should implants be considered for patients with periodontal disease?

Dental implants are seen as a good option for replacing missing teeth. The success and survival rates for implants are very high. Concerns are developing about the problem of peri-implantitis. The reports of its prevalence vary but it is noted that the presence of periodontal disease is a risk factor. The issue of peri-implantitis was raised in the House of Lords in 2014. Complaints relating to implants is on the rise with the General Dental Council. Placement of implants in patients with periodontal disease is not a treatment that should be done without a full periodontal assessment and stabilisation of periodontal disease first. This review considers the risk of placing implants in patients with aggressive and chronic periodontitis.

Removal techniques for failed implants.

The use of dental implants is an accepted and predictable way of replacing missing or lost teeth. However, implants can and will fail and there are a variety of reasons why this occurs, which the practitioner should understand. In some instances failed implants may require removal and, therefore, practitioners should be aware of techniques that can be used to remove failed implants to potentially enable future rehabilitation of an edentulous region.

Clindamycin and dentistry.

Clindamycin is an antimicrobial agent that dentists use in the UK for infective endocarditis prophylaxis but rarely for other clinical situations that require antimicrobial intervention. This has been largely due to its association with acute pseudomembranous colitis. Up to date information on the efficacy and safety of this antimicrobial agent should be known before prescription.

Does your practice website need updating?

The internet is becoming a more and more powerful tool and many dental practitioners use it to advertise their dental service; some dental practices even offer on-line appointment booking! It is not unreasonable to surmise that use of the internet is likely to become increasingly common practice by dentists in the future. This is not surprising as the World Wide Web (WWW) provides an opportunity for dentists to advertise themselves and their practices to a wide audience in a relatively economical manner.

[Induced sputum in children and adolescents with asthma: safety, clinical applicability and inflammatory cells aspects in stable patients and during exacerbation]. / Escarro induzido em crianças e adolescentes com asma: segurança, aplicabilidade clínica e perfil de células inflamatórias em pacientes estáveis e durante exacerbação.

OBJECTIVES: To determine the safety of sputum induction in asthmatic children and adolescents, to characterize sputum inflammatory cells while clinically stable and during exacerbation and to correlate sputum inflammatory cells with peripheral blood eosinophils, serum IgE and the degree of bronchial obstruction. METHODS: Ninety-six asthmatic patients aged 6 to 18 years were recruited for the present cross-sectional study. Spirometry was performed before and after administration of a bronchodilator. Sputum was collected spontaneously or after induction by the inhalation of saline solution at increasing concentrations. Blood samples were obtained for serum IgE and eosinophil quantification. RESULTS: Sputum samples adequate for analysis were obtained from 68 (70.8%) of the patients recruited. No relevant bronchoconstriction was observed during induction. The presence of a larger number of eosinophils in sputum did not correlate with more clinically severe asthma. No correlation was observed between the degree of bronchial obstruction, measured based on FEV1, and inflammatory cells in sputum, peripheral blood eosinophils or serum IgE. Larger numbers of neutrophils were observed in the asthma exacerbation group (p < 0.05). CONCLUSIONS: Sputum induction was found to be a safe procedure for obtaining clinical samples from children and adolescents even during exacerbations, allowing for clinical and functional limitations. The 67% induction success rate was considered satisfactory. In this group of patients, receiving inhaled corticosteroids, eosinophil quantification did not distinguish between the clinical and functional severity of asthma and was independent of the degree of airway obstruction. A proportional predominance of neutrophils was observed in the sputum of patients with asthma exacerbation.

Minimal residual disease in bone marrow transplant recipients with chronic myeloid leukemia.

Bone marrow samples of 70 transplant recipients with CML were studied by Southern blot analysis and RT-PCR using a two-step procedure with nested primers. Twenty-two patients were studied once and 48 were assessed on multiple occasions. All patients remained in a hematological remission during the study. The time of follow-up after the transplant ranged from 2 to 144 months with a median of 42 months. Thirty-nine patients (56%) were negative by RT-PCR and Southern blot studies at the time of their last evaluation. The proportion of RT-PCR negative patients increased with the duration of follow-up after the transplant; 36% of patients were RT-PCR negative after 1 year compared with 60% after 2 years and 78% after > or = 5 years. Patients maintained on immunosuppression had a higher probability of remaining RT-PCR positive. Age, sex, time from diagnosis to BMT, as well as acute and chronic GVHD did not influence the RT-PCR status. The majority of patients studied on multiple occasions demonstrated a stable RT-PCR and Southern blot pattern. Some showed uni- or multi-directional transitions. However, none of the patients studied progressed to a hematological relapse. RT-PCR studies on colonies grown from RT-PCR positive. Southern blot negative patients confirmed that some of the clonogenic progenitors are able to produce BCR/ABL transcripts.

Azithromycin and dentistry - a useful agent?

OBJECTIVES: Azithromycin has recently replaced clindamycin oral suspension for prop hylaxis of infective endocarditis (IE) in children. It is also currently recommended by the American Heart Association as an alternative to penicillin, along with clindamycin for prophylaxis of infective endocarditis in adults. The objectives of this paper were to firstly, review the current literature on the efficacy of azithromycin as a suitable prophylactic agent in the prevention of infective endocarditis; and secondly, to review its pharmacological properties as a suitable therapeutic agent in the management of odontogenic infections. DESIGN: A review of the literature. CONCLUSIONS: The available evidence from animal models on infective endocarditis supports the efficacy of this drug as a prophylactic agent against oral streptococci. The pharmacological properties of this agent would make it a very promising therapeutic adjunct in the management of odontogenic infections. At present there are only a small number of studies available with valuable data on the efficacy of this relatively new drug. Further investigations comparing this compound with other commonly used adjuncts would be of great benefit.

Associated postmortem dental findings as an aid to personal identification.

The use of the unique features of the human dentition to aid in personal identification is well accepted within the forensic field. Indeed, despite advances in DNA and other identification methodologies, comparative dental identifications still play a major role in identifying the victims of violence, disaster or other misfortune. The classic comparative dental identification employs the use of postmortem and antemortem dental records (principally written notes and radiographs) to determine similarities and exclude discrepancies. In many cases the tentative identification of the individual is unknown and therefore antemortem records cannot be located. In such a situation a dental profile of the individual is developed to aid the search for the individual's identity. With such a profile a forensic odontologist can identify and report indicators for age at time of death, race (within the four major ethnic groups) and sex. In addition to these parameters the forensic dentist may be able to give more insight into the individual. This paper outlines, for the non-expert, some of the additional personal information that can be derived from the teeth of the deceased, and which may assist in their ultimate identification.

Summary of: Tooth-whitening activity of a novel home-bleaching systemutilising thermal diffusion: a multifactorial simultaneous evaluation of efficacy at cervical, body and incisal tooth sites.

INTRODUCTION: The ability of a thermal diffusion system (TDS) to promote the tooth-whitening actions of a bleaching gel/bleaching activator combination product (containing a final hydrogen peroxide (H(2)O(2)) content of 10.0% (w/v)) towards discoloured 'smile-zone' teeth was examined. METHODS: Fifty teeth in 15 participants aged 18-62 years were investigated. The CIE tooth shade parameters L(*), a(*) and b(*), together with Vitapan shade scores (VSSs), were simultaneously recorded at three separate tooth areas (cervical, body and incisal sites) with a novel spectrophotometric monitoring system before treatment, and also at 14 days after completion of a 10-day treatment period in which the product was applied 'at-home' (twice daily). RESULTS: The tooth-whitening treatment administered gave rise to extremely significant increases in L(*), and decreases in the a(*) and b(*) shade parameters for each of the tooth areas investigated (p <10(-)10). Post-treatment mean decreases in the VSS values were 8.26, 9.70 and 9.14 for the cervical, body and incisal areas respectively (p <10(-8) in each case). Mean ΔE values determined post-treatment were also very highly significant for each tooth region examined (p <10(-)10 in each case). CONCLUSIONS: The tooth-whitening system tested exerted extremely powerful bleaching actions in all tooth areas investigated. The order of tooth-whitening effectiveness was body > incisal > cervical for Δb(*) and ΔE, and incisal > body > cervical for Δa(*) and ΔL(*), and this may reflect the TDS's ability to promote the penetration of H(2)O(2) to intrinsic stain sites.

An in vitro study on the use of circumferential matrix bands in the placement of Class II amalgam restorations.

OBJECTIVE: To compare the effectiveness of a disposable metal matrix band system and the Siqveland matrix system in the restoration of a Class II preparation with amalgam. To assess the difference in amalgam overhang produced between the two systems in vitro. METHODS: A right maxillary first premolar with a Class II cavity preparation was duplicated in acrylic to produce a standardized cavity. Forty acrylic teeth were individually mounted in a hand-held model of an upper right quadrant and restored with amalgam by twenty dentists. Each dentist restored two replica teeth with amalgam; one using the Omni-matrix system and the other using the Siqveland matrix system. All 40 restored teeth were individually mounted on a standardised jig, viewed under a microscope, photographed and overhangs, if present, measured using Image ProPlus 4.0. A comparison of the overhangs produced by the two systems was analysed using a paired sample t-test. RESULTS: An overhang was present in all cases. There was a significant difference in the size of the overhangs produced by the two different matrix systems (p-value 0.036). The Siqveland produced a larger overhang than the Omni-matrix system. CONCLUSION: A commonly used matrix band (Siqveland), when compared to a newer, disposable system (Omni-matrix), was found to result in consistently larger overhangs during the restoration of class II preparations with amalgam. As Omni-matrix is a disposable system, the potential for cross-contamination is removed and it can, therefore, be considered a suitable replacement for the non-disposable Siqveland matrix system.

The teaching of implant dentistry in undergraduate dental schools in the United Kingdom and Ireland.

OBJECTIVES: The objective of this paper is to describe the contemporary teaching of dental implantology to dental undergraduates in the United Kingdom and Ireland. The paper also aims to assess the attitudes of dental school educators in relation to future trends in dental implant training for dental undergraduates. METHODS: An online questionnaire relating to current and future possible trends in dental implantology education was developed and distributed to Heads of Division/Departments of Restorative Dentistry, or equivalent, in each of the 15 dental schools with undergraduate dental programmes in the United Kingdom and Ireland. The questionnaire included both 'open' and 'closed' style questions. RESULTS: All 15 dental schools invited to participate in this survey responded. Of the 15 schools, two do not provide any training for their undergraduate dental students in relation to implant dentistry. The teaching is mainly delivered in lecture-based or phantom head room settings (eight of the 13 implant-teaching schools). Only four schools allow their students to interact clinically with implant patients. All schools anticipate an increase in dental implant teaching in the next five years, however, there is much variation in the scope and nature of this increase. CONCLUSIONS: The teaching of dental implants in the UK and Ireland has increased since the time of previous surveys. It would seem prudent for this theme of teaching to further increase in order to best prepare graduating students for independent clinical practice.