Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

BACKGROUND/AIM: Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. MATERIAL/METHODS: Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. RESULTS: Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. CONCLUSIONS: Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

"I think that comes with experience": A thematic analysis exploring how dental students at a transitional stage of training understand and engage with reflection.

INTRODUCTION: Reflection is an important skill for dentists but there is little consensus about how reflection can most usefully be integrated into dental education. The aim of this study was to conduct focus groups to explore how students at a transitional point of dental education in one UK dental school had experienced, and conceptualised reflection. METHODS: Students at the beginning of their clinical studies were recruited by email and invited to attend a single focus group. Focus groups were co-facilitated by a team of staff and student researchers and analysed using thematic analysis. Students acted as research partners in planning a topic guide, recruiting students, conducting focus groups and considering the implications of research findings for the curriculum, and contributed their perspectives to other aspects of the research. RESULTS: Students primarily associated reflection with their clinical learning and valued the skill highly in this context. They were less familiar with the potential for reflection to support personal development and deeper learning. Themes were identified of learning, uncertainty, emotions and wellbeing, community and challenges and are discussed in detail. CONCLUSION: Reflection is highly valued within our dental education setting but many students may be missing out on using it to its' full potential. Changes to the undergraduate curriculum, including offering reflection from an early stage of education may be warranted.

Psychological therapies for temporomandibular disorders (TMDs).

BACKGROUND: Temporomandibular disorders (TMDs) are a group of musculoskeletal disorders affecting the jaw. They are frequently associated with pain that can be difficult to manage and may become persistent (chronic). Psychological therapies aim to support people with TMDs to manage their pain, leading to reduced pain, disability and distress. OBJECTIVES: To assess the effects of psychological therapies in people (aged 12 years and over) with painful TMD lasting 3 months or longer. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched six bibliographic databases up to 21 October 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of any psychological therapy (e.g. cognitive behaviour therapy (CBT), behaviour therapy (BT), acceptance and commitment therapy (ACT), mindfulness) for the management of painful TMD. We compared these against control or alternative treatment (e.g. oral appliance, medication, physiotherapy). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We reported outcome data immediately after treatment and at the longest available follow-up. We used the Cochrane RoB 1 tool to assess the risk of bias in included studies. Two review authors independently assessed each included study for any risk of bias in sequence generation, allocation concealment, blinding of outcome assessors, incomplete outcome data, selective reporting of outcomes, and other issues. We judged the certainty of the evidence for each key comparison and outcome as high, moderate, low or very low according to GRADE criteria. MAIN RESULTS: We identified 22 RCTs (2001 participants), carried out between 1967 and 2021. We were able to include 12 of these studies in meta-analyses. The risk of bias was high across studies, and we judged the certainty of the evidence to be low to very low overall; further research may change the findings. Our key outcomes of interest were: pain intensity, disability caused by pain, adverse events and psychological distress. Treatments varied in length, with the shortest being 4 weeks. The follow-up time ranged from 3 months to 12 months. Most studies evaluated CBT.   At treatment completion, there was no evidence of a benefit of CBT on pain intensity when measured against alternative treatment (standardised mean difference (SMD) 0.03, confidence interval (CI) -0.21 to 0.28; P = 0.79; 5 studies, 509 participants) or control (SMD -0.09, CI -0.30 to 0.12; P = 0.41; 6 studies, 577 participants). At follow-up, there was evidence of a small benefit of CBT for reducing pain intensity compared to alternative treatment (SMD -0.29, 95% CI -0.50 to -0.08; 5 studies, 475 participants) and control (SMD -0.30, CI -0.51 to -0.09; 6 studies, 639 participants). At treatment completion, there was no evidence of a difference in disability outcomes (interference in activities caused by pain) between CBT and alternative treatment (SMD 0.15, CI -0.40 to 0.10; P = 0.25; 3 studies, 245 participants), or between CBT and control/usual care (SMD 0.02, CI -0.21 to 0.24; P = 0.88; 3 studies, 315 participants). Nor was there evidence of a difference at follow-up (CBT versus alternative treatment: SMD -0.15, CI -0.42 to 0.12; 3 studies, 245 participants; CBT versus control: SMD 0.01 CI - 0.61 to 0.64; 2 studies, 240 participants). There were very few data on adverse events. From the data available, adverse effects associated with psychological treatment tended to be minor and to occur less often than in alternative treatment groups. There were, however, insufficient data available to draw firm conclusions. CBT showed a small benefit in terms of reducing psychological distress at treatment completion compared to alternative treatment (SMD -0.32, 95% CI -0.50 to -0.15; 6 studies, 553 participants), which was maintained at follow-up (SMD -0.32, 95% CI -0.51 to -0.13; 6 studies, 516 participants). For CBT versus control, only one study reported results for distress and did not find evidence of a difference between groups at treatment completion (mean difference (MD) 2.36, 95% CI -1.17 to 5.89; 101 participants) or follow-up (MD -1.02, 95% CI -4.02 to 1.98; 101 participants). We assessed the certainty of the evidence to be low or very low for all comparisons and outcomes. The data were insufficient to draw any reliable conclusions about psychological therapies other than CBT. AUTHORS' CONCLUSIONS: We found mixed evidence for the effects of psychological therapies on painful temporomandibular disorders (TMDs). There is low-certainty evidence that CBT may reduce pain intensity more than alternative treatments or control when measured at longest follow-up,  but not at treatment completion. There is low-certainty evidence that CBT may be better than alternative treatments, but not control, for reducing psychological distress at treatment completion and follow-up. There is low-certainty evidence that CBT may not be better than other treatments or control for pain disability outcomes.  There is insufficient evidence to draw conclusions about alternative psychological therapeutic approaches, and there are insufficient data to be clear about adverse effects that may be associated with psychological therapies for painful TMD.  Overall, we found insufficient evidence on which to base a reliable judgement about the efficacy of psychological therapies for painful TMD. Further research is needed to determine whether or not psychological therapies are effective, the most effective type of therapy and delivery method, and how it can best be targeted. In particular, high-quality RCTs conducted in primary care and community settings are required, which evaluate a range of psychological approaches against alternative treatments or usual care, involve both adults and adolescents, and collect measures of pain intensity, pain disability and psychological distress until at least 12 months post-treatment.

Primary Care Dentists' management of permanent dentition traumatic dental injuries in 7- to 16-year-olds: A sequential mixed-methods study.

BACKGROUND/AIMS: Primary care dentists play a pivotal role in the management of traumatic dental injuries in children, despite little evidence on the barriers they face in providing care. The aim of this study was to explore and contextualize the knowledge and attitudes of general dental practitioners regarding their management of permanent dentition traumatic dental injuries in children aged 7-16 years old. MATERIAL AND METHODS: A two-phase sequential mixed-methods study included a questionnaire that was disseminated to all 619 primary care dentists, identified via a triangulated sampling strategy, based across the north-east of England (Phase I). Statistical analyses were performed using Mann-Whitney U- and Kruskal-Wallis tests, Spearman's correlation and chi-square test. Multivariate factor analysis, with principal components extraction, was used to test between multiple ordinal variables. Respondents were invited to a face-to-face or telephone semi-structured interview (Phase II). Interviews were transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Primary care dentists were less confident in managing complex dental trauma. Inadequate financial remuneration was the main reason for not providing care, often prompting a referral to the local dental hospital. This was more apparent for those who qualified before 2000. More recently qualified dentists felt the long-term costs, related to traumatic dental injuries, were insufficiently remunerated. Most still provided emergency management, irrespective of remuneration, as long as they had the requisite knowledge and skills. Four major themes arose: impact of traumatic dental injuries on patients, parents and primary care dentists; barriers to providing treatment; educational opportunities for primary care dentists; and interactions between primary and secondary care services. CONCLUSIONS: There is high confidence in managing simple traumatic dental injuries but less for complex injuries. A lack of sufficient financial remuneration associated with the long-term management of dental trauma was the main barrier for dentists to manage these cases.

Are different pulp treatment techniques and associated medicaments effective for the treatment of extensive decay in primary teeth?

Data sources Cochrane Oral Health's Trials Register and Central Register of Controlled Trials, Medline Ovid, Embase Ovid, Web of Science, Open Grey, US National Institutes of Health Ongoing Trials Register and World Health Organisation International Clinical Trials Registry Platform. There were no restrictions on language or publication dates.Study selection Two reviewers selected randomised clinical trials (RCTs) comparing different pulp interventions in extensively decayed primary teeth, which combined a pulp treatment technique and a medicament.Data extraction and synthesis Data were extracted independently by two reviewers recording year of publication, country of origin, inclusion/exclusion criteria, description of interventions, sample size, mean age, duration of follow-up and outcome data. Risk of bias was assessed by two reviewers. Meta-analysis was performed on RCTs comparing different medicaments for the same pulp technique or different pulp treatment techniques with each other.Results Eighty-seven RCTs were included in qualitative synthesis, yielding 59 studies for meta-analysis. The 87 RCTs involved 7,140 randomised teeth with 17 split-mouth RCTs and 70 parallel arm design. In total, 125 different comparisons were examined using clinical and radiological failure rates; 75 compared different pulpotomy agents or techniques, 25 compared different pulpectomy agents, four compared pulpotomy and pulpectomy, and 21 compared different agents for direct pulp capping. Where possible, data were compared for 6, 12 and 24 months. For pulpotomy, mineral trioxide aggregate (MTA) appears least likely to fail over those time periods. For pulpectomy, results were inconclusive comparing failure rates between various agents; however, two RCTs found a lower failure rate for zinc oxide-eugenol (ZOE) compared with Vitapex. For direct pulp capping, there was a low number of studies undertaking the same comparisons; calcium silicates (eg MTA and Biodentine) hold future promise.Conclusions Overall, evidence quality ranged from moderate to very low. For pulpotomy, MTA may be the best pulpotomy medicament in primary molars. Formocresol is effective but generally accepted as toxic. Biodentine, enamel matrix derivatives, laser application or Ankaferd Blood Stopper (a plant-based haemostatic agent used to control gastrointestinal bleeds) appear to be second choices. If all of these are unavailable, an application of sodium hypochlorite may be the safest option. For pulpectomy, evidence was inconclusive; however, ZOE paste may be more effective than Vitapex, but no further conclusions could be made. For direct pulp capping, the evidence was of low to very low quality. The best alternative may be a tricalcium silicate, especially MTA. Future RCTs may change these findings.

Do composite restorations in primary molar teeth have a higher survival rate following total or selective caries removal?

Study design A double-blind randomised clinical trial, conducted between June 2009 and June 2011, in a paediatric dental department in a Brazilian dental school.Study selection Children aged 3-8 years, in good general health, with deep carious lesions (caries radiographically located in the inner quarter of dentine) affecting either one or two surfaces in primary molars were eligible for inclusion. Teeth were excluded if clinical or radiographic evidence of pulpal inflammation or necrosis or clinical mobility were observed. Pre-cooperative children were also excluded.Clinical procedures and success criteria Following a coin toss, 120 teeth were randomly assigned to two groups: 55 in the total caries removal (TCR) group and 65 in the selective caries removal (SCR) group. Procedures were carried out by three paediatric dentists under local anaesthesia and restored, using a layering technique, with composite under rubber dam. Restorations were evaluated at 3, 6, 12, 18, 24 and 36 months, using the US Public Health Service (USPHS) scale, by a single-blinded and calibrated examiner. A Charlie or Delta score, on the USPHS scale, at the margins of the restorations was considered as restoration failure. Gingival bleeding score, type of cavity (one or two surfaces) and presence of caries (active or inactive) were recorded as secondary outcomes; however, presence alone did not constitute restoration failure.Results Average survival rate of restorations across all teeth was 68% after 36 months, with SCR statistically significantly lower at 57% compared to TCR at 81% (p = 0.004). Annual failure rates for SCR and TCR were 17.3% and 6.7%, respectively. Two-surface restorations had lower survival rates (58%) compared to single-surface restorations (87%) (p = 0.02). Type of cavity and gingival bleeding statistically influenced the chance of restoration failure at 36 months.Conclusions Composite restorations placed after SCR in primary molars were found to fail more often compared to those restored after TCR. Two-surface cavities and poor gingival health negatively impacted restoration success.

The Early Erosive and Abrasive Challenge: A Profilometric, Electron Microscopic and Microhardness Study Using Human, Bovine and Ovine Enamel.

AIM: This study aimed to test the null hypothesis that there are no significant differences in surface characteristics of eroded and abraded human, ovine and bovine enamel. DESIGN: Twenty enamel slabs were prepared from bovine, human and ovine incisor crowns, and randomly assigned to one of 4 treatments: 30 second/4 minute immersion at 1%/6% w/v citric acid. Post-erosion, an oscillatory brush was used for 20 seconds. Roughness parameters, height change and scanning electron microscopy were measured at each stage. RESULTS: Whilst the eroded surface became generally less rough after the abrasive challenge, there were significant tissue differences. Abraded microhardness was significantly increased compared to eroded values (P⟨0.001), Surface loss was also significantly different between tissue types (P⟨0.001). Bovine enamel showed similar trends to human enamel but was consistently harder and more resistant to surface change. Ovine enamel displayed little correlation with human enamel.Scanning electron microscopy images showed differences for each tissue that were consistent with the quantitative data. CONCLUSIONS: The null hypothesis was rejected; neither bovine nor ovine enamel can be reliably used interchangeably with human enamel for erosion/abrasion studies.

Nutrient intake and dietary patterns of relevance to dental health of 12-year-old Libyan children.

OBJECTIVE: There are few data on the dietary intake of children in Libya, and none on free sugars intake. The present study aimed to report the intake of macronutrients and eating habits of relevance to dental health in a group of Libyan schoolchildren and to investigate any gender differences for these variables. DESIGN: Dietary information was obtained from a randomly selected sample using an estimated 3 d food diary. Dietary data were coded using food composition tables and entered into a Microsoft® Access database. Intakes of energy, macronutrients, sugars and the amount of acidic items consumed were determined using purpose-written programs. SETTING: Benghazi, Libya. SUBJECTS: Schoolchildren aged 12 years. RESULTS: One hundred and eighty children (ninety-two boys and eighty-eight girls) completed the study. Their mean age was 12·3 (sd 0·29) years. The average daily energy intake was 7·01 (sd 1·54) MJ/d. The percentage contributions to energy intake from protein, fat and carbohydrate were 16 %, 30 % and 54 %, respectively. Total sugars contributed 20·4 % of the daily energy intake, and free sugars 12·6 %. The median daily intake of acidic items was 203 g/d, and of acidic drinks was 146 g/d. There were no statistically significant differences in nutrient intakes between genders. Intake of acidic items was higher in girls (P < 0·001). CONCLUSIONS: The contribution to energy intake from macronutrients was in accordance with global nutrition guidelines. The acidic drinks intake was low compared with other populations, while free sugars intake was above the recommended threshold of 10 % of energy intake.

Exploring dental academics' perceptions of and experience with discrimination in the UK and Ireland: a qualitative study.

Introduction Diversity is known to be important but diversity of dental school academics in the UK and Ireland is low in comparison with the dental profession and the overall population. The aims were to explore whether UK and Ireland dental school academics are satisfied with their career progression, whether they believe that there are barriers to career progression in dental schools based on protected characteristics, and experience of discrimination at work.Methods An online survey, including four free-text questions related to the study aims, was circulated by the Dental Schools Council to dental academics at all UK and Ireland dental schools. Qualitative content analysis was used to analyse free-text comments.Results and discussion There were 192 responses from 20 dental schools. Five data categories were constructed which highlight the impact of discrimination in dental academia, the importance of opportunities and support, different perspectives of diversity and discrimination, and academic and institutional culture.Conclusion Staff perceived and experienced barriers to career progression. Many were satisfied with their career progression, but a proportion of staff expressed dissatisfaction and attributed this to discrimination based upon protected characteristics. The culture in dental schools is beginning to change to address factors contributing to inequality in dental academia.

Dental caries and its association with diet and dental erosion in Libyan schoolchildren.

BACKGROUND. The change towards a more Westernised diet in Libya may increase the risk of caries and erosion in children. AIMS. To investigate any association between dental caries, dental erosion, and potential dietary risk factors in Libyan schoolchildren. METHODS. A random sample of 791 schoolchildren aged 12 years underwent dental examination for caries and erosion and completed a questionnaire to provide dietary data. Dental caries was assessed using the WHO (Oral Health Surveys: Basic Methods, 1997) criteria. Erosion was assessed using UK National Diet and Nutrition Survey (NDNS, Young People Aged 4-18 years. Volume 2: Report of the Oral Health Survey, 2000) criteria. Associations between caries and dietary variables were investigated through bivariate and multivariate analyses. RESULTS. Of the 791 12-year olds, 57.8% (457) had caries experience and 40.8% (323) had experience of erosion. One hundred and ninety-two subjects (42%) of the subjects with caries experience also had erosion, whilst 131 subjects (39.2%) of the 334 without caries had clinical signs of erosion (P = 0.464; OR, 1.123; 95% CI, 0.842, 1.497). There was no statistically significantly relationship between dental caries and dental erosion. Frequency of consumption of fruit-based sugared drinks was statistically significantly positively associated with experience of caries (P = 0.002). CONCLUSIONS. Dental caries experience was associated with frequency of consumption of sugared dietary items but not with dental erosion.

A student-led qualitative study to explore dental undergraduates' understanding, experiences, and responses to racism in a dental school.

OBJECTIVES: This qualitative study explored dental student participants' understanding of racism, their experiences, and responses to racism in dental school, and the impacts of their experiences. METHODS: An interpretative phenomenological analysis design recruited students from the undergraduate dental degree and the BSc in Oral Health Science course at a UK dental school in December 2020. Two students and a qualitative researcher facilitated the online focus groups. A topic guide including scenario questions guided the discussions that lasted an average of 2 h. The recorded interviews were transcribed and analyzed using thematic analysis. RESULTS: Twenty-five participants took part in five focus groups. Several themes emerged related to participants' experiences and reactions. They described a spectrum of racist encounters ranging from more subtle forms, such as stereotyping and microaggression to racial mocking. They were concerned about professionalism, not knowing how and when to respond to patients' racist behavior. They described gender discrimination and intersectional biases but felt compelled to put patients' interests first. They were unsure about how to respond to stereotyping or racism from staff because of perceived imbalances in the staff-patient-student triad relationship. They expressed fears of gaslighting and despondency. They also felt that the COVID-19 pandemic and anonymity from virtual learning environments enabled racist behavior. CONCLUSION: This study revealed a complex triad relationship between participants, staff and patients, and experience of intersectionality and three levels of racism: interpersonal, structural, and institutional. It highlighted the need for further research to develop actions including structural policies and equality and diversity training.

Prevalence and severity of dental caries in Libyan schoolchildren.

OBJECTIVES: To assess prevalence and severity of dental caries, examine gender differences and assess the relationship of dental caries to socioeconomic status in a group of Libyan schoolchildren. DESIGN AND SETTING: A cross sectional observational study with cluster sampling within schools. PARTICIPANTS: A random sample of 791, 12-year-olds in 36 elementary public schools in Benghazi. METHODS AND MAIN OUTCOME MEASURES: Dental caries was assessed using the DMFT and DMFS indices and WHO (1997) criteria. Information about socioeconomic status was collected through a dental health questionnaire. RESULTS: The prevalence of dental caries was 57.8%. The mean DMFT and DMFS indices were 1.68 (SD ± 1.86) and 2.39 (SD ± 3.05) for all subjects and 2.90 (SD ± 1.56) and 4.14 (SD ± 2.97) for subjects with caries experience. Dental caries was more prevalent amongst girls (P = 0.002). There was a statistically significantly negative association between dental caries and the level of father's education (P = 0.015). CONCLUSIONS: While dental caries prevalence in 12 year-old Libyan children was high, the mean DMFT was low compared with other developing countries, but higher than the WHO goal for year 2020. The high level of untreated caries is a cause for concern, representing a high unmet treatment need.

A review on dental whitening.

OBJECTIVES: To provide a narrative review on vital dental whitening chemistry, toxicity and safety, vital dental whitening techniques, whitening systems, potential side effects of whitening and cyclic whitening using products with a range of concentrations and pH values. In addition, new developments and recommendations in the field of vital dental whitening will be presented to help clinicians understand the whitening process, its advantages, limitations, and the impact of whitening concentration and pH on enamel providing guidance in tailoring whitening treatments. DATA: Data were gathered using the following keywords: dental whitening, roughness, hardness, sensitivity, hydrogen peroxide, whitening pH, whitening concentration, whitening chemistry, colour, and toxicity. SOURCES: An electronic search was performed using PubMed and Scopus databases. Bibliographic material from papers reviewed was then used to find other relevant publications. CONCLUSIONS: The effectiveness of vital dental whitening depends on many factors, such as the concentration/pH of the whitening agent, application duration, chemical additives, and re-mineralising agents used. Developing new whitening products and technologies such as nano-additives and alternative carrier systems is showing promising results, and might prove efficient in maximising whitening benefits by accelerating the whitening reaction and/or minimising expected reversible/irreversible enamel structural damage.

Transatlantic engagement: a novel dental educational exchange.

Introduction Newcastle University School of Dental Sciences (NUSDS) and Indiana University School of Dentistry in the United States of America (IUSD) are like-minded institutions committed to civic engagement. Over the last 15 years, both universities have built civic engagement into the dental curricula, however each institution operates within significantly different healthcare systems.Aim Co-development of unique collaborative dental education; the first UK/US educational exchange programme engaged with the dental student community.Design A dental educational exchange was developed enabling NUSDS and IUSD students to learn alongside each other within dental and community settings in both countries. Students participate in a unique face-to-face collaborative and interdisciplinary education programme within respective dental schools and by a series of video conferences scheduled before on-site visits. They gain mutual awareness of delivery, access to care and possible barriers facing patients relating to the oral healthcare systems in England, the state of Indiana and the USA. Logistical considerations were significant, aided by scoping visits to the respective partner school and video conferencing. Planning encompassed timetable restrictions, scheduling student video conferences, students' clinical access/observerships, occupational health clearances, overall educational content, student/staff evaluation and potential areas for education research.Conclusions Currently in its fourth year, this is a unique example of a collaborative educational exchange between the UK and USA.

Mineral trioxide aggregate in paediatric dentistry.

OBJECTIVE: The aim of this study was to present a review of the reported literature on: (i) the physical and chemical properties; and (ii) clinical applications of mineral trioxide aggregate (MTA) in the practice of paediatric dentistry. METHOD: Electronic literature search of scientific papers from January 1993 to June 2008 was carried out on the MEDLINE, Embase, Entrez Pubmed, and Scopus databases using specific key words. The search yielded 448 papers, out of which 100 were identified as conforming to the applied criteria. These papers formed the basis of the review and the clinical scenarios presented which demonstrate the application of MTA in the practice of paediatric dentistry. CONCLUSION: Paediatric dentists have successfully employed MTA in a variety of endodontic/restorative applications since the late 1990s. Clinical impressions have generally been favourable and support the findings of laboratory and animal-based investigations. Very few clinical studies have been reported so far in humans, and although these have been positive, the body of research is currently insufficient to enable a meaningful systematic review and meta-analysis.

Dental caries and its association with sociodemographics, erosion, and diet in schoolchildren from southeast Brazil.

PURPOSES: The purposes of this study were to determine the prevalence of caries in a sample of Brazilian schoolchildren, test associotions between caries, sociodemographics, and erosion, and investigate potential dietary factors common to both conditions. METHODS: Brazilian schoolchildren (13-14 years old) completed a questionnaire to provide dietary information and underwent dental examination. Sociodemographic characteristics were collected using a questionnaire completed by parents/guardians. Caries was assessed using decayed, missing, filled teeth/ surfaces (DMFT/DMFS) indices. Erosion was assessed using a previously validated index. RESULTS: Of 458 schoolchildren, 78% had caries experience. A statistically significantly lower prevalence of caries was observed in children from a higher economic class and whose parents had higher educational levels. Thirty-five percent of children with caries also had erosion, while 32% with a DMFT of 0 had erosion (P = .72). The frequency of consumption of drinks and foods was not statistically significantly associated with caries. The intake of sugared carbonated drinks was statistically significantly associated with erosion (P = .01). The mothers' educational level was the only variable independently associated with caries experience (P = .04). CONCLUSIONS: Dental caries was associated with sociodemographics, but not with erosion. There were no dietary factors identified in common for caries and erosion.

Obtaining patient feedback for quality assurance of undergraduate dental teaching.

Introduction In order to achieve the educational standards of the General Dental Council, providers of UK dental education programmes are required to demonstrate that feedback from patients is collected and used to inform programme development. Aims To determine areas of undergraduate dental training programmes that patients feel able to comment upon, allowing development of a patient feedback questionnaire. Methods Patients receiving treatment from undergraduate students were recruited to focus groups (n = 5, n = 6) where their experience of receiving student care was explored. Audio transcriptions were analysed for emergent themes. These themes informed the design of a questionnaire which was presented to a further patient focus group (n = 4) for content and face validity testing. Staff (n = 4) and student (n = 8) focus groups discussed its delivery. Results Patients were able to comment upon treatment quality, safety, the student-teacher interaction, and appointment times. An 18-question questionnaire was developed to include free text comments and answers on a visual analogue scale. It was modified following focus groups with patients, staff, and students. Conclusion Patients undergoing student treatment identified aspects of the clinical teaching programme that could be included in a feedback questionnaire. Following a pilot, the questionnaire will form part of the teaching quality assurance process.

Diet and dental erosion in young people in south-east Brazil.

BACKGROUND: The regular consumption of acidic foods and drinks may be associated with dental erosion, and soft drink consumption appears to be increasing both in developed and developing countries. Dentists are aware that an acidic diet can contribute to the development of erosion; however, there may be confusion within the profession concerning the general health message of eating five portions of fruits and vegetables each day. OBJECTIVE: The aim of this study was to investigate associations between dental erosion and the consumption of acidic foods and beverages in schoolchildren in south-east Brazil. The objective was to gather information, by means of a dietary questionnaire, on frequency of intake and patterns of consumption of acidic foods and drinks in a group of schoolchildren. The hypothesis was that the experience of dental erosion among the study sample was associated with the frequency and pattern of consumption of soft drinks, fruit juices, fruits, and yogurt. METHODS: A cross-sectional study was conducted in Três Corações, south-east Brazil. A sample of 458 schoolchildren, mean age 13.8 (SD 0.39) years, completed the study. Information about potential dietary risk factors for dental erosion was collected through a questionnaire survey completed by the schoolchildren. For the dental examinations, the subjects were examined for dental erosion in a school room. Associations between dental erosion and the variables under study were investigated through processes of bivariate and multivariate analyses. The statistical significance level was set at 5%. RESULTS: Analysis of the questionnaire surveys showed that the frequency of consumption of sugared carbonated drinks was the only variable independently associated with the erosive process, with subjects who had a daily consumption of such drinks having a greater likelihood of having erosion (P = 0.015, odds ratio 1.752, 95% confidence interval 1.116-2.750). CONCLUSIONS: Of all tested factors in this sample of schoolchildren the consumption of sugared carbonated drinks is most associated with dental erosion.

"New age" pulp therapy: personal thoughts on a hot debate.

This article outlines the counterpoint delivered in the debate "Is Formocresol Obsolete?" It addresses the opinion supporting the need to move away from formaldehyde-containing preparations in the dental care of children. It is suggested that such a move should be made not just because of concerns relating to the possible toxicity of formaldehyde but to reflect a more contemporary, biologic approach to pulp therapy in the primary dentition.