Dental practice in the UK in 2015/2016. Part 2: aspects of direct restorations, bleaching, endodontics and paediatric dentistry

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.

Influence of Professional Teeth Whitening on Oral Hygiene: Long-term Results

Aims:

The aim of this article is to estimate the long-term influence of professional dental bleaching on quality of oral hygiene (year after procedure).

Materials and Methods:

A randomized controlled prospective clinical repeated study was carried out 6 months after the previous one, i.e., 1 year after the oral hygiene procedure, among 60 patients divided into two groups. In the first group, professional oral hygiene and bleaching using 25% hydrogen peroxide were performed. In the second group only, oral hygiene was performed. Dynamics of hygienic index of Quigley-Hein modified by S. Turesky was estimated.

Results:

In the first group, the average value of the hygienic index of Quigley-Hein modified by S. Turesky was significantly lower a year after procedure than before (1.33±0.09 and 2.34±0.14, respectively). In the second group, this index exceeded 2.45 and nearly returned to the initiated level (2.45±0.07 and 2.44±0.08, respectively). Patients underwent professional teeth whitening in the long-term period, and the level of oral hygiene was significantly higher than that in the control group.

Conclusion:

Professional dental bleaching has good long-term influence on the level of oral hygiene and serves as a significant motivation factor for maintaining health of oral cavity.

An internet-mediated investigation into the reported clinical use of rubber dam isolation by GDPs in the UK - part 2: clinical applications

Aims To investigate the reported clinical applications of rubber dam isolation by UK general dental practitioners (GDPs) using an internet-mediated approach.Methods The data were collected in 2019, using an online (SurveyMonkey) questionnaire that was distributed to GDPs in a private group on Facebook. The percentages are based on the number of respondents who answered each question.Results The response rate was 61% with 403 valid completed questionnaires. The majority (395; 98%) of respondents reported using rubber dam in clinical practice. Undergraduate training in rubber dam use was received by 382 (98%) respondents, with greater training reported by younger, more recently qualified graduates. The main clinical applications of rubber dam included its use for composite restorations, endodontic treatments and internal bleaching procedures, while for other clinical procedures, the majority of respondents did not use rubber dam. For posterior and anterior composites, 332 (82%) and 298 (74%) respondents, respectively, reported using rubber dam isolation at least rarely. At least 98% (395) of the respondents used rubber dam for endodontic procedures, irrespective of tooth type and position. Over 70% (281) of respondents reported using rubber dam at least rarely for internal bleaching. Rubber dam was used by 99% (392) and 67% (262) of respondents on adults and paediatric patients, respectively.Conclusions The main clinical applications agree with previous reports, but highlight an increase in rubber dam use. This study investigated a wider range of clinical applications compared to previous studies, adding to the literature surrounding rubber dam use.

An internet-mediated investigation into the reported clinical use of rubber dam isolation by GDPs in the UK - part 1: factors influencing rubber dam use

Aims To investigate the reported use of rubber dam isolation by UK general dental practitioners (GDPs), utilising an internet-mediated (SurveyMonkey) questionnaire reporting the demographic profile of respondents and the attitudes and factors influencing rubber dam use.Methods A piloted questionnaire was distributed to a random sample of GDPs in a private Facebook group, investigating respondent demographics, clinical applications, and attitudes towards and factors influencing rubber dam use. The data were analysed using descriptive statistics along with chi-squared and pairwise Mann-Whitney U tests.Results The response rate was 61%, with 403 valid completed questionnaires. Of these, 218 (54%) were female and 185 (46%) were male, with an age range of 23-72 years. Most of them (248; 62%) worked in mixed practices. The majority agreed that rubber dam aids placement of posterior restorations (311; 78%), provides clearer access (308; 76%), enables a higher clinical standard (355; 89%) and increases restoration longevity (257; 65%). Most agreed that proper isolation for root canal/operative procedures cannot be achieved without rubber dam use (329; 82%). Respondents disagreed with the following statements: root canal therapy completed without rubber dam isolation is as successful as those completed using rubber dam (338; 85%), rubber dam is difficult to apply (292; 73%) and rubber dam is disliked by patients (257; 64%). Respondents agreed that rubber dam use is influenced by clinical setting (259; 64%), procedure (390; 97%), choice of material being placed (382; 95%) and ease of application (337; 84%). Furthermore, 218 (54%) of the respondents expressed an interest in further training in rubber dam use.Conclusions This study provides greater insight into the attitudes and factors influencing rubber dam use, while demonstrating an interest in further training.

Amalgam Phase-Down Part 1: UK-Based Posterior Restorative Material and Technique Use

Introduction:

A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use. The current use of amalgam and its alternatives has not been fully investigated in the United Kingdom.

Objectives:

The study aimed to identify direct posterior restorative techniques, material use, and reported postoperative complication incidence experienced by primary care clinicians and differences between clinician groups.

Methods:

A cross-sectional survey was distributed to primary care clinicians through British dentist and therapist associations (11,092 invitations). The questionnaire sought information on current provision of direct posterior restorations and perceived issues with the different materials. Descriptive statistical and hypothesis testing was performed.

Results:

Dentists’ response rate was 14% and therapists’ estimated minimum response rate was 6% (total N = 1,513). The most commonly used restorative material was amalgam in molar teeth and composite in premolars. When placing a direct posterior mesio-occluso-distal restoration, clinicians booked on average 45% more time and charged 45% more when placing composite compared to amalgam (P < 0.0001). The reported incidences of food packing and sensitivity following the placement of direct restorations were much higher with composite than amalgam (P < 0.0001). Widely recommended techniques, such as sectional metal matrix use for posterior composites, were associated with reduced food packing (P < 0.0001) but increased time booked (P = 0.002).

Conclusion:

Amalgam use is currently high in the publicly funded sector of UK primary care. Composite is the most used alternative, but it takes longer to place and is more costly. Composite also has a higher reported incidence of postoperative complications than amalgam, but time-consuming techniques, such as sectional matrix use, can mitigate against food packing, but their use is low. Therefore, major changes in health service structure and funding and posterior composite education are required in the United Kingdom and other countries where amalgam use is prevalent, as the amalgam phase-down continues.

Knowledge Transfer Statement:

This study presents data on the current provision of amalgam for posterior tooth restoration and its directly placed alternatives by primary care clinicians in the United Kingdom, where publicly funded health care with copayment provision predominates. The information is important to manage and plan the UK phase-down and proposed phase-out of amalgam and will be of interest to other, primarily developing countries where amalgam provision predominates in understanding some of the challenges faced.

Applications of nano-materials in diverse dentistry regimes

Research and development in the applied sciences at the atomic or molecular level is the order of the day under the domain of nanotechnology or nano-science with enormous influence on nearly all areas of human health and activities comprising diverse medical fields such as pharmacological studies, clinical diagnoses, and supplementary immune system. The field of nano-dentistry has emerged due to the assorted dental applications of nano-technology. This review provides a brief introduction to the general nanotechnology field and a comprehensive overview of the synthesis features and dental uses of nano-materials including current innovations and future expectations with general comments on the latest advancements in the mechanisms and the most significant toxicological dimensions.

Dental practice in the UK in 2015/2016. Part 3: aspects of indirect restorations and fixed prosthodontics

Objective

This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials.

Methods

The data presented were extracted from the data obtained from a validated,121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations.

Results

A response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material.

Conclusion

Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pinscontinued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry.