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Optical resonances in bipartite metal nanostructure lattices are more resilient to finite size-effects than equivalent unipartite lattices, but the complexities of their behaviour in non-ideal settings remain relatively unexplored. Here we investigate the quality factor and extinction efficiency of 1D Ag and Au unipartite and bipartite lattices. By modelling finite size lattices over a range of periods we show that the quality factor of Ag bipartite lattices is significantly better than unipartite lattices. This improvement is less pronounced for Au bipartite lattices. We also show that bipartite lattices are dramatically affected by structure size variations at scales that are typically seen in electron beam lithography fabrication in contrast to unipartite lattices, which are not as sensitive.
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OBJECTIVES: This review aimed to determine how successful aging is operationalized in the oral heath context, and to determine the use of Patient Reported Outcomes (PROs) and Dental Patient Reported Outcomes (dPROs). METHODS: A scoping review was conducted and was registered with PROSPERO (CRD42021232668). The reporting of the review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. RESULTS: Five databases were searched and 1288 potentially relevant publications were identified. A total of 263 'effective' studies informed this review. Most studies were observational in nature (94.3%, 250) and the majority were cross-sectional (52.5%, 139). Most studies (89.4%, 235) were unidimensional in their operationalization of successful aging. Successful aging was mainly operationalized in terms of the 'biomedical model' (81.4%, 214) with limited consideration of psychological and social dimensions/models. Regarding biological health, commonly considered components were 'nutrition' (33.6%, 72/214) and 'longevity' (28.9%, 62/214). PROs were most frequently employed in the assessment of nutrition (88.8%, 64/72), albeit in response to standardized assessments. Regarding the psychological dimension (28.9%, 76), 'cognition' was most frequently assessed (69.7%, 53/76) - typically by the use of PROs (83.0%, 44/53). Social dimensions were only rarely considered (1.5%, 4). In terms of oral health - a range of aspects were considered including: 'number of teeth' (58.2%, 153 - dPROs (31.6%, 49/155)); and prosthesis use (30.4%, 80 - dPROS (31.3%, 25/80)). CONCLUSION: The operationalization of successful aging in oral health is typically unidimensional and focuses primarily on the 'biomedical model'. PROs and dPROS are both widely used in the assessment of successful aging in the oral health context.
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Saúde Bucal , Medidas de Resultados Relatados pelo Paciente , Envelhecimento , Cognição , HumanosRESUMO
OBJECTIVES: This systematic review and meta-analysis was undertaken to answer the following focus questions: Is the implant survival in augmented bone utilizing iliac crest bone grafts the same as while using intraoral autologous bone grafts? Is the incidence of postoperative donor site complications the same when using iliac crest bone grafts as opposed to intraoral grafts? METHODS: Systematic searches of electronic databases (PubMed, Embase, CENTRAL) were performed to identify studies which reported on implant survival and postoperative complications for dental implants placed in grafted partially/completely edentulous human jaws. Studies were included if: they reported on 2-piece micro-rough surface root form dental implants placed in bone-augmented completely or partially edentulous human jaws, and the jaws must have been augmented with autologous bone graft materials. Time and nature of postoperative complications must have been reported. Two investigators performed data extraction and a Cohen's unweighted kappa was calculated for inter-investigator reliability. A meta-analysis was performed for the extracted data on implant survival rate in both iliac crest grafts and intra-oral grafts. A qualitative analysis was performed on the information extracted on graft donor site complications. Quality assessment of the included studies were done using the Cochrane collaboration tool and the Newcastle-Ottawa scales. RESULTS: A total of 23 studies were included in the final analysis. The calculated kappa ranged between 0.77-0.89 for the literature search and identification process. Fourteen studies were included with data on implant survival including five randomized controlled clinical trials. The meta-analysis of included studies revealed that the implant survival rate of dental implants placed in jaws augmented with iliac crest grafts was lower than those placed in jaws augmented with intra-oral bone grafts at 6-months [ICGâ¯=â¯95.8% IOGâ¯=â¯98.4%; P < .001], 12-months [ICGâ¯=â¯97.0%, IOGâ¯=â¯98.4%; P < .001], 24-months [ICGâ¯=â¯85.9%, IOGâ¯=â¯98.2%; P < .001], 60-months [ICGâ¯=â¯90.0%, IOGâ¯=â¯91.5%; P < .001], and at 120-months [ICGâ¯=â¯88.8%, IOGâ¯=â¯95.2%; P < .001] follow-up periods. Iliac crest grafts were also frequently associated with donor site complications including pain / discomfort, gait disturbance, and sensory disturbance. CONCLUSIONS: This systematic review and meta-analysis demonstrates that implant survival is consistently higher in bone harvested from intraoral sites compared to iliac crest grafts. Donor site complications seemed to be a frequent finding with iliac crest grafts and mental grafts. FUNDING: None. REGISTRATION: The review protocol was registered with PROSPERO: International prospective register of systematic reviews (CRD42021283738).
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Aumento do Rebordo Alveolar , Implantes Dentários , Arcada Edêntula , Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Implantação Dentária Endóssea , Humanos , Arcada Edêntula/cirurgia , Complicações Pós-Operatórias/cirurgia , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
As natural teeth are lost, many older adults choose softer foods lacking in essential micronutrients and fiber, yet replacing missing teeth alone does not positively influence diet. Dietary intervention in combination with treatment to replace missing teeth is increasing, though understanding of effective intervention components is limited. This systematic review synthesized literature relating to oral rehabilitation coupled with dietary intervention in adults. The primary outcome was dietary intake; secondary outcomes pertained to oral health and dietary intervention characteristics including: theoretical basis and behavior change techniques (BCTs). MEDLINE, Web of Science, PubMed and CENTRAL were searched. Nine studies were included. Study designs were heterogeneous involving 526 participants. Narrative synthesis identified improvements in at least one aspect of participants' oral health (i.e. biting/chewing) alongside at least one positive diet/nutrition outcome post-intervention for all studies. F/V results were pooled for three studies using meta-analysis techniques resulting in a standardized mean difference (SMD) of 0.29 [CI -0.54, 1.12], p = 0.49, but with marked heterogeneity (p = 0.0007). Few interventions were theory-based and intervention components were poorly described. Overall, narrative synthesis indicated support for dietary intervention coupled with oral rehabilitation on diet. Meta-analysis was only possible with three studies highlighting limitations. Large-scale, appropriately described trial methodologies are needed.Trial registry: This review was prospectively registered with PROSPERO on the 11 July 2017 [CRD42017071075].
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Implantes Dentários , Dieta , Educação em Saúde , Terapia Nutricional , Estado Nutricional , Adulto , Fibras na Dieta , Humanos , MicronutrientesRESUMO
BACKGROUND: Many factors determine dietary intake in older adults, including physical health, psychological well-being and socio-economic status. Dental status may also be important. The aim was to examine how dental status impacts perceived ability to eat to certain foods, nutrient intake and nutritional status in UK older adults. METHODS: Data collected by the National Diet and Nutrition Survey Rolling Programme was analysed. A 4-day food diary assessed dietary intake, while a Computer Assisted Personal Interview collected socio-demographic, health behaviour and oral health information. Participants aged 65 years and over (n = 1053) were categorised into three groups according to their dental status: edentate with dentures (E-DEN, n = 292), dentate with dentures (D-DEN, n = 305) or dentate with no dentures (DEN, n = 456). A total of 515 participants provided a blood sample that was used to assess nutrient concentrations including vitamin B12, vitamin C, ferritin, vitamin B6 (pyridoxal-5-phosphate, PLP), retinol, ß-carotene and 25-hydroxyvitamin D (25-OH-D). Multiple regression methods were performed to examine cross-sectional associations between dental status, food selection, nutrient intake and nutritional status. RESULTS: Both E-DEN and D-DEN groups, compared with the DEN group, were more likely to report difficulty eating apples, raw carrots, lettuce, nuts, well-cooked steak and crusty bread (P < 0.01). No group differences were observed in perceived ability to eat sliced bread, sliced cooked meats and cheese. The E-DEN group compared with the DEN group had lower mean daily intakes of omega 3 fatty acids (P = 0.006), non-starch polysaccharides (P = 0.001), ß-carotene (P = 0.001), folate (P = 0.001), vitamin C (P = 0.008), magnesium (P < 0.001) and potassium (P < 0.001), and had lower plasma vitamin B6 PLP (P = 0.001), vitamin C (P = 0.009) and ß-carotene (P = 0.015) concentrations, after adjusting for socio-demographic and health behavioural factors. Compared with the DEN group, the D-DEN group did not have lower nutrient intakes or lower blood nutrient concentrations. CONCLUSIONS: Within this sample of older adults, impaired dental status appears to influence food selection, and intake of important nutrients. Future research should focus on developing dental interventions coupled with dietary counselling to encourage the adoption of healthy eating habits in this high-risk population group.
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Dentaduras/estatística & dados numéricos , Preferências Alimentares/psicologia , Inquéritos Nutricionais , Idoso , Estudos Transversais , Dentição Permanente , Nível de Saúde , Humanos , Reino UnidoRESUMO
Data sources Medline, Cochrane Central, Cochrane Database of Systematic Reviews, National Health Service Economic Evaluation Database, Health Technology Assessment Database, Web of Science and the abstracts of conference proceedings for International Association for Dental Research meetings.Study selection Randomised controlled trials (RCTs), non-RCTs, and cohort studies measuring pre-treatment to post-treatment change in oral health-related quality of life (OHRQoL) score using validated measures were included.Data extraction and synthesis Two reviewers independently screened and selected studies, and extracted data. Risk of bias was assessed independently using the Cochrane tool for RCTs and the Newcastle Ottawa Scale for non-randomised studies. Random effects meta-analysis was used to compare change in OHRQoL scores.Results Twenty one cohort studies and two RCTs were included. Eight studies investigated implant-supported crowns (ISCs), ten studies reported on implant-supported fixed dental prostheses (IFDPs), nine on dental prostheses (TFDPs) and two implant-supported removable dental prostheses (IRDPs). Seventeen papers contributed to the meta-analysis. At nine months the pooled mean OHRQoL change was 15.3 for TFDP, 11.9 for RPD, and 14.9 for IFDP and the pooled standardised OHRQoL change >9 months was 13.2 for TFDP and 15.8 for IFDP. Direct comparisons nine months between TFDP against IFDP and RPD against IFDP significantly favoured IFDP in both cases.Conclusions TFDP and IFDP had short- and long-term positive effects on OHRQoL. RPDs positively affected OHRQoL in the short term. IFDP showed greater short-term improvement in OHRQoL than RPD and TFDP.
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Saúde Bucal , Qualidade de Vida , Coroas , Prótese Dentária Fixada por Implante , Humanos , Medicina EstatalRESUMO
This study aimed to collect data on the oral health status of patients undergoing treatment for head and neck oncology across Northern Ireland. Data were collected on all patients referred to the Northern Ireland Multidisciplinary Head and Neck Oncology Team for discussion and treatment planning. Each patient underwent pre-treatment dental assessment in the Centre for Dentistry, Queen's University Belfast, between June 2013 and November 2014. Data were collected from clinical oral examinations supplemented with intra-oral radiographs. During the course of the study 96 patients were assessed and the levels of dental disease observed in this cohort were high. On clinical examination 43% were diagnosed with caries and 46% with periodontal disease. Ten patients were completely edentate. The disease profile of this patient group presents significant challenges to dental services tasked with rendering patients dentally fit prior to undergoing oncology treatment.
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Neoplasias de Cabeça e Pescoço/terapia , Nível de Saúde , Saúde Bucal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Coortes , Comorbidade , Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca Edêntula/epidemiologia , Avaliação das Necessidades/estatística & dados numéricos , Terapia Neoadjuvante/estatística & dados numéricos , Irlanda do Norte/epidemiologia , Planejamento de Assistência ao Paciente , Doenças Periodontais/epidemiologia , Radiografia Dentária/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Fumar/epidemiologia , Extração Dentária/estatística & dados numéricosRESUMO
Management of head and neck oncology necessitates an extensive multidisciplinary approach. Throughout Northern Ireland all oral care for Head and Neck Oncology patients is overseen within the Centre for Dentistry, Queens University Belfast via referral from the Head and Neck Multidisciplinary Team. The aim of this study was to develop and introduce a referral pro-forma to improve communication between members of the multidisciplinary team and ultimately expedite provision of oral care prior to patients undergoing treatment for Head and Neck Oncology. The study period ran from June 2013 until November 2014. All patients undergoing treatment for Head and Neck Oncology in Northern Ireland were included in the study. A referral pro-forma was introduced in June 2014 in an attempt to streamline the referral process. Data was gathered on patient waiting times, extraction protocols with comparisons made between the period before and after introduction of the pro-forma. In total 137 patients were included in the study: 96 patients were referred to the service using referral letters, confidential emails and via telephone; 41 patients were referred using the pro-forma. The introduction of the referral pro-forma resulted in a significant decrease in the mean number of days from referral to assessment (12 to 7 days) (p < 0.05) and significantly increased mean interval time between extractions and patients beginning radiotherapy (13 to 17 days) (p < 0.05). Significant improvements have been made with the introduction of the referral pro-forma where patients are waiting significantly less time for dental assessment and having extractions completed in a more timely manner therefore expediting the commencement of their oncology treatment.
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Assistência Odontológica para Doentes Crônicos , Neoplasias de Cabeça e Pescoço/terapia , Encaminhamento e Consulta , Estudos de Coortes , Comunicação , Procedimentos Clínicos , Humanos , Relações Interprofissionais , Prontuários Médicos , Irlanda do Norte , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Fatores de Tempo , Extração Dentária , Listas de EsperaRESUMO
Data sourcesPubMed, Medline, Cochrane Library, Embase and Science Direct.Study selectionStudies published in English providing data on patients with shortened dental arch (SDA) and extreme SDA (ESDA) and masticatory performance with removable dental prostheses (RDP) were included.Data extraction and synthesisTwo reviewers independently selected studies and abstracted data, with disagreements being resolved by discussion.ResultsEight studies were included; four reported on comminution studies, three on mixing ability and one included both. In patients with ESDA comminution or mixing ability was 28-39% lower compared to patients with a complete dentition. In two studies, comminution outcomes when chewing with an RDP ranged from 2% to 32% reduction, indicating better chewing function (smaller X50) compared to comminution without the RDP. One study reported 28-83% lower mixing ability when chewing at the RDP side than chewing at the dentulous side. Generally, more artificial teeth (or longer occlusal platform) in experimental RDPs resulted in better comminution and better mixing ability (significant in four out of five studies), indicating a 'dose-effect' relationship. Two of the eight studies reported on biting force with higher maximum occlusal force for biting with natural teeth than for biting with artificial teeth in a distal-extension RDP.ConclusionsWithin the limitations of this review it can be concluded that subjects with (E)SDA had a reduced masticatory performance in the order of 30-40%. Distal-extension RDPs compensated for this reduction only partially, namely in the order of 50%. RDP effects on chewing frequency were not conclusive.
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Arco Dental/anatomia & histologia , Prótese Parcial Removível , Mastigação/fisiologia , Odontologia Baseada em Evidências , Humanos , Arcada Parcialmente Edêntula/reabilitaçãoRESUMO
OBJECTIVES: The rapidly ageing world has placed considerable demands on health and social care. To address this, the World Health Organization (WHO) and United Nations (UN) have declared action for this decade (2021-2030) to promote healthy ageing. Operationalisation of successful ageing in the oral health context in terms of its dimensions and their interconnectedness was determined. METHODS: A citation analysis was conducted following a scoping review to determine oral health's relationship with 5 key dimensions of successful ageing. This included examining the occurrence and co-occurrence amongst dimensions and over time. Specific consideration of citations by country, journal type, and authors through overlay visualisation was performed to map their interconnectedness. RESULTS: The scoping review identified 263 publications covering 1730 specific terms. There was a growing interest in successful ageing in the oral health context, mostly in the past decade (2010 onwards; 65.8%, 173 publications). The dimension of key consideration was "health and ADLs" (activities of daily living); this dimension appeared in 97.3% of publications (n = 256) and was found earliest to emerge, with the greatest link strengths compared to other dimensions. Country-level variations in citation data were observed, and there was good citation interconnectedness between them. Key oracles for dissemination have been medical rather than dental-specific journals. Amongst authors, there was considerable interconnectedness in the field. CONCLUSIONS: Findings highlight how successful ageing in the oral health context has been studied, with implications for addressing the significance of oral health to older peoples' lives in line with the WHO and UN's agenda. Citation analyses identified the "known unknowns" area for further consideration, and these findings have the potential to inform how dental research may best move forward with the successful ageing agenda to bring about translational impact.
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OBJECTIVES: To elicit head and neck cancer (HANC) patients' views about their oral health and to identify potential issues regarding compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease. METHODS: A purposive sample of twelve HANC patients between 6- and 12-months post-radiotherapy were recruited to undergo a semi-structured interview with a qualitative researcher. A pre-piloted topic guide was used to frame each interview. Qualitative data were analysed via thematic analysis. RESULTS: Data were categorised into four main themes - 'How HANC patients perceive oral health', 'Cancer diagnosis and cancer care pathway', 'Impact of oncology treatment (radiotherapy, surgery, and chemotherapy)', and 'Post-oncology treatment recovery', with 14 subthemes. Oral health was viewed as an important component of HANC patients' overall physical and mental health post-treatment. Patients' non-compliance with adequate oral hygiene practice was related to oral mucositis, a "burning" sensation associated with high fluoride toothpaste, forgotten or inconsistent clinical advice, and an inadequate supply of preventive oral hygiene products. The potentially highly cariogenic nature of prescribed nutritional supplements for patients at risk of malnutrition did not tend to be communicated to patients in advance of their prescription. CONCLUSIONS: Adequate oral health is essential for the overall physical and mental well-being of post-treatment HANC patients. Non-compliance with preventive clinical advice increases the risk of post-treatment oral health deterioration and was related to miscommunication, inadequate supplies of oral hygiene products, and treatment-related oral discomfort. CLINICAL SIGNIFICANCE: Post-treatment HANC patients are at increased risk of dental disease. Educational and behavioural techniques should be employed to enhance patients' compliance with clinical oral hygiene and dietary advice for the prevention of post-radiotherapy dental disease. Patients should be informed about the potentially highly cariogenic nature of nutritional supplements, and these patients should undergo frequent dental recall. Clinical advice regarding oral hygiene and dietary practices needs to be given consistently to HANC patients by different specialists of the HANC multidisciplinary team.
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Neoplasias de Cabeça e Pescoço , Doenças Estomatognáticas , Humanos , Higiene Bucal , Saúde Bucal , Cooperação do Paciente , Neoplasias de Cabeça e Pescoço/radioterapiaRESUMO
We describe a technique for experimentally determining the spatial-frequency modulation transfer function for near-field super-resolution imaging systems and present such a modulation transfer function for a 20|40|20 nm poly(vinyl alcohol)~(PVA)|Silver|PVA superlens exposed to 365 nm wavelength (i-line) radiation through a 50-nm thick tungsten mask. An extensive spectral characterization is achieved from only two exposures, with transmission coefficients determined for spatial frequencies as high as 13 µm-1, corresponding to λ / 4.75. The resulting transfer function is in good agreement with analytical models that incorporate the effects of mask-superlens interactions.
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Algoritmos , Desenho Assistido por Computador , Lentes , Prata/química , Desenho de Equipamento , Análise de Falha de EquipamentoRESUMO
OBJECTIVE: To develop consensus from experts in Restorative Dentistry based in the United Kingdom (UK) on the most appropriate tooth replacement strategies in adult patients with reduced dentitions using a modified Delphi analysis. METHODS: An expert panel of UK specialists (n=20) in Restorative Dentistry or Prosthodontics were asked to answer the following question: using available evidence and your clinical experience, how appropriate is each tooth replacement strategy for each clinical scenario of tooth loss in the mandible presented? Five specific clinical patterns of tooth loss were presented to panellists using clinical photographs, and using a 9-point Likert scale, they were asked to rate the appropriateness of listed tooth replacement strategies during two Delphi rounds. The target level of consensus for each statement was 70%. RESULTS: Consensus was reached on the appropriateness of thirty-seven tooth replacement strategies (37%) across ten clinical scenarios. Of these, thirteen were considered appropriate (13%) and twenty-four were considered inappropriate (24%). CONCLUSION: The results from this Delphi process represent the consensus professional views of an expert panel of UK specialists in Restorative Dentistry and Prosthodontics. CLINICAL SIGNIFICANCE: Tooth replacement for partially dentate patients is a common clinical consideration. This study provides evidence from a Delphi process to help clinicians and patients make informed choices about appropriate and inappropriate treatment options.
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Perda de Dente , Adulto , Consenso , Técnica Delphi , Dentição , Humanos , Reino UnidoRESUMO
OBJECTIVES: To achieve consensus amongst an expert panel of prosthodontics/restorative dentistry academics on the best undergraduate teaching and assessments, and to develop recommendations regarding teaching and assessment of undergraduate prosthodontics. METHODS: Semi-structured electronic questionnaires were used to collect data from senior clinical academics involved in the teaching of prosthodontics on three consecutive occasions (Delphi method). The questionnaires asked the experts' opinion on best teaching and assessment methods in the undergraduate prosthodontics curriculum. Invitation emails, with a hyperlink to the Round 1 questionnaire, were sent to 36 international dental academic experts. In later rounds, panellists were invited to consider their previous responses in light of the overall group response in attempt to bring the panel to a consensus. The group response was summarized using simple descriptive statistics, and the target level of consensus for each question was set at ≥ 70%. A response rate of at least 70% between rounds was deemed appropriate to maintain rigour. RESULTS: Twenty-three senior academic experts from eleven countries agreed to participate. Eighteen (representing nine different countries) completed the questionnaires in its entirety (response rate 78.3%). The number of statements that attained consensus agreement was much higher than the number of non-consensus statements-92.6%, 175 statements out of 189 over three iterative rounds. Only 14 statements did not obtain a consensus during this Delphi study. CONCLUSIONS: A total of 175 consensus statements represent the agreement expert views of participated senior academics in prosthodontics from nine different countries and across four continents. These consensus statements could be considered detailed guidelines and recommendations to improve future undergraduates' curriculum in prosthodontics. CLINICAL SIGNIFICANCE: This Delphi study achieved a high consensus among a panel of senior academics in the teaching and assessment of undergraduate prosthodontics. This consensus could help minimise the current international and national divergence in dental schools' prosthodontics curricula, which could benefit future dentists and, subsequently, the patients.
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Currículo , Prostodontia , Consenso , Humanos , Estudantes , Inquéritos e Questionários , EnsinoRESUMO
Post-radiotherapy head and neck cancer patients are at increased risk of dental caries due to radiotherapy-induced salivary gland hypofunction and radiation-damage to tooth structure. Dental caries may cause pain and discomfort, and is likely to have a detrimental impact on patients' quality of life. This systematic review appraised and synthesised best available evidence regarding the incidence and severity of post-radiotherapy dental caries in head and neck cancer patients. Six databases and two trial registries were searched from their inception to May 2019. A total of 22 papers met the inclusion criteria. The pooled percentage of patients that developed dental caries post-radiotherapy was 29% (n = 15 studies; 95% CI 21%, 39%; I2 = 88.0%). Excluding studies with longer than two years follow-up, the pooled percentage was 37% (n = 9 studies; 95% CI 25%, 51%; I2 = 88.6%). Meta-regression analysis revealed that studies with a higher mean/median radiotherapy dose exposure, had an increased incidence of dental caries (p = 0.02). Furthermore, studies with a higher proportion of patients treated with chemotherapy in addition to radiotherapy, had an increased incidence of dental caries (p = 0.02) after the exclusion of an outlier. It is important to be mindful of the high degree of observed heterogeneity and the inclusion of a large number of non-randomised studies. Data regarding the number of carious teeth, the number of carious tooth surfaces, and the number of carious lesions developed post-radiotherapy was unsuitable for meta-analysis. There is a need for well-designed research studies to improve understanding of dental caries-risk in post-radiotherapy head and neck cancer patients.
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Cárie Dentária/epidemiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia/efeitos adversos , Quimiorradioterapia/efeitos adversos , Cárie Dentária/etiologia , Relação Dose-Resposta à Radiação , Humanos , Incidência , Qualidade de Vida , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: To gain a consensus from consultants in restorative dentistry about the types of teeth that should be extracted from head and neck cancer patients (HNC) pre-radiotherapy. MATERIALS: Literature- and clinician-informed questionnaires were emailed to an 'expert panel' of consultants (nâ¯=â¯24/28; 86%) in the United Kingdom (UK) and Ireland on three consecutive occasions (Delphi rounds). The results of Round 1 were used to revise the questionnaire that was distributed in Round 2, and this procedure was repeated for Round 3. During Rounds 2 and 3, participants were asked to indicate, on a 5-point Likert scale, their level of agreement with a series of statements on the types of teeth that should be extracted pre-radiotherapy. The target level of consensus for each statement was 70%. RESULTS: In Round 2, there was consensus-agreement for 69 of 102 statements (i.e.â¯≥â¯70% of participants rated 'agree' or 'strongly agree' to the relevant statement). Consensus agreement was also achieved for 20 of 28 statements in Round 3. Therefore, a total of 89 consensus statements are presented that illuminate the decision-making process for the pre-radiotherapy extraction of molar, premolar, and anterior teeth with periodontal pocketing, furcation disease, mobility, caries, tooth-wear, apical disease, or other pathology. CONCLUSION: The statements represent the consensus professional views of participated consultants in restorative dentistry in the UK and Ireland regarding the types of teeth that should be extracted from HNC patients pre-radiotherapy. The results provide a platform for the development of future guidelines. CLINICAL SIGNIFICANCE: Pre-radiotherapy dental assessments for head and neck cancer patients are considered mandatory. This study presents different criteria that should be considered for the treatment planning of these patients in relation to pre-radiotherapy extractions, according to the collective consensus opinion of participated consultants in restorative dentistry in the UK and Ireland.
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Neoplasias de Cabeça e Pescoço , Técnica Delphi , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Inquéritos e Questionários , Extração Dentária , Reino UnidoRESUMO
OBJECTIVES: To compare the success of two different tooth replacement strategies for partially dentate older adults; namely resin bonded bridgework (RBB) provided to restore patients according to the principles of the shortened dental arch concept (SDA) and conventional full-arch rehabilitation with removable dental prostheses (RDPs). METHODS: A randomised controlled clinical trial (RCT) was conducted with partially dentate adults aged 65â¯years or older. Each patient from the RDP group had all missing natural teeth replaced with cobalt-chromium framework RDPs. Each patient from the SDA group was restored to 10 occluding pairs of natural and replacement teeth using RBB. Patients were followed-up at 6, 12, 24, 36 months. Success rates were generated according to defined success criteria. Log-rank tests and Cox's proportional hazard models were used to compare the success of the two treatment strategies. RESULTS: After 36 months, 89 patients completed the RCT; nâ¯=â¯45 in the RDP group and nâ¯=â¯44 in the SDA group. The overall success rate of the SDA treatment was 90.4% compared to 73.0% for RDPs (pâ¯=â¯0.005). In the upper arch SDA treatment was 100% successful compared to 86.4% for RDPs (pâ¯=â¯0.019). In the lower arch, lower success rates were reported for both the SDA treatment (80.0%) and RDPs (60.0%) (pâ¯=â¯0.054). Further analyses with cox's proportional hazard models demonstrated that SDA treatment was significantly more successful than RDPs (Hazard Ratio: 2.47, pâ¯=â¯0.04). CONCLUSIONS: After 36 months SDA treatment using RBB was significantly more successful than RDPs used for conventional full-arch rehabilitation in partially dentate older adults. CLINICAL SIGNIFICANCE: Functionally orientated treatment according to the principles of the SDA is a feasible alternative to RDPs for partially dentate older patients. SDA treatment using RBB can achieve higher success rates compared to RDPs in this patient group.
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Prótese Parcial Removível , Arcada Parcialmente Edêntula , Perda de Dente , Dente , Idoso , Arco Dental , Humanos , Análise de SobrevidaRESUMO
BACKGROUND: The World Health Organization declared the outbreak of COVID-19 to be an international pandemic in March 2020. While numbers of new confirmed cases of the disease and death tolls are rising at an alarming rate on a daily basis, there is concern that the pandemic and the measures taken to counteract it could cause an increase in distress among the public. Hence, there could be an increase in need for emotional support within the population, which is complicated further by the reduction of existing face-to-face mental health services as a result of measures taken to limit the spread of the virus. OBJECTIVE: The objective of this study was to determine whether the COVID-19 pandemic has had any influence on the calls made to Samaritans Ireland, a national crisis helpline within the Republic of Ireland. METHODS: This study presents an analysis of calls made to Samaritans Ireland in a four-week period before the first confirmed case of COVID-19 (calls=41,648, callers=3752) and calls made to the service within a four-week period after a restrictive lockdown was imposed by the government of the Republic of Ireland (calls=46,043, callers=3147). Statistical analysis was conducted to explore any differences between the duration of calls in the two periods at a global level and at an hourly level. We performed k-means clustering to determine the types of callers who used the helpline based on their helpline call usage behavior and to assess the impact of the pandemic on the caller type usage patterns. RESULTS: The analysis revealed that calls were of a longer duration in the postlockdown period in comparison with the pre-COVID-19 period. There were changes in the behavior of individuals in the cluster types defined by caller behavior, where some caller types tended to make longer calls to the service in the postlockdown period. There were also changes in caller behavior patterns with regard to the time of day of the call; variations were observed in the duration of calls at particular times of day, where average call durations increased in the early hours of the morning. CONCLUSIONS: The results of this study highlight the impact of COVID-19 on a national crisis helpline service. Statistical differences were observed in caller behavior between the prelockdown and active lockdown periods. The findings suggest that service users relied on crisis helpline services more during the lockdown period due to an increased sense of isolation, worsening of underlying mental illness due to the pandemic, and reduction or overall removal of access to other support resources. Practical implications and limitations are discussed.
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The use of transfer-matrix analyses for characterizing planar optical superlensing systems is studied here, and the simple model of the planar superlens as an isolated imaging element is shown to be defective in certain situations. These defects arise due to neglected interactions between the superlens and the spatially varying shadow masks that are normally used as scattering objects for imaging, and which are held in near-field proximity to the superlenses. An extended model is proposed that improves the accuracy of the transfer-matrix analysis, without adding significant complexity, by approximating the reflections from the shadow mask by those from a uniform metal layer. Results obtained using both forms of the transfer matrix model are compared to finite element models and two example superlenses, one with a silver monolayer and the other with three silver sublayers, are characterized. The modified transfer matrix model gives much better agreement in both cases.
Assuntos
Algoritmos , Desenho Assistido por Computador , Lentes , Modelos Teóricos , Simulação por Computador , Desenho de Equipamento , Análise de Falha de Equipamento , Luz , Espalhamento de RadiaçãoRESUMO
OBJECTIVES: To explore the long-term impact for patients living with an obturator prosthesis, following a maxillectomy for a head and neck neoplasm. METHODS: A qualitative approach was employed, using semi-structured interviews. A purposive sample of eight men and four women, living with an obturator prosthesis for at least five years, were recruited. Interviews were digitally recorded and transcribed. Using thematic analysis, two researchers analysed the data. RESULTS: The data were categorised into four themes: 1. Preparedness for living with an obturator, 2. Impact of living with an obturator - what changes to expect, 3. Stability and retention of the obturator, and 4. Coping strategies to aid adjustment. Long-term effects of living with an obturator spanned many aspects of life to include: chewing and eating, speaking, dealing with nasal leakage and altered body image, employment and intimacy issues, along with embarrassment during social encounters. Optimal retention and stability of the obturator, as perceived by the patient, lead to improved social confidence and engagement. The emotional impact varied greatly on peoples' lives. CONCLUSIONS: Patients experiencing the greatest long-term challenges had larger defects, were of employment age and had not returned to work. Gaining an improved understanding of the psychology of coping overtime is clearly important, as this can inform interventions to facilitate adjustment for those who are emotionally struggling. Furthermore, the findings of this study could inform the design of a communication tool to facilitate shared-decision making and aid preparedness for living with an obturator following a maxillectomy. CLINICAL SIGNIFICANCE: The multidisciplinary head and neck team should provide patients with detailed pre-operative information, including potential effects on social, work and personal relationships. The restorative dentistry team has a pivotal role in the long-term management of these patients, as obturators have a finite lifespan with ongoing maintenance necessary to promote optimal retention and stability.