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Eliyas S, Shah K, Dhamecha N, Jayaram T, Yusuf A, Jasani V, Kaur N. GIRFT and Measuring Outcomes in MCNs: endodontics in 646 teeth treated in Tier 2 (Primary Care) and Tier 3 (Secondary Care) settings in England. Prim Dent J 2024; 13:36-52. [PMID: 38888078 DOI: 10.1177/20501684241230799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
AIM This paper aims to assess the complexity, quality and outcome of endodontic treatment provided in Managed Clinical Networks (MCNs) in England to understand if we are "getting it right first time" (GIRFT). METHODS In a convenient sample of endodontic treatments provided between May 2011 and April 2017, the complexity of teeth treated, the quality of treatment procedure, the radiographic appearance of root fillings, as well as clinical and radiographic healing were retrospectively assessed using records taken as part of treatment. Trained, calibrated examiners independently scored radiographs using previously published scoring systems. RESULTS 646 teeth were followed up for 24.7 months (standard deviation [SD] 17.08). The average age of those patients treated was 46.7 years (SD 15.38) with 48.3% being male. Of teeth treated, 70.4% were of complexity level 3. 88.2% of teeth were asymptomatic, and 80% demonstrated complete radiographic healing. Procedural errors inhibited achieving correct working length and taper, with more voids within root canal fillings. When patency filing was reported as being carried out, complete radiographic healing was more likely. CONCLUSIONS It is possible to collate outcome data in the NHS system, especially if there is provision for ongoing follow up and time allocated for collection of data. Endodontic treatment provided within primary and secondary care settings are of high quality, with outcomes being better with single operators carrying out high volumes of endodontic treatment.
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Affiliation(s)
- Shiyana Eliyas
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
| | - Kewal Shah
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
| | - Nalin Dhamecha
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
| | - Tapasya Jayaram
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
| | - Aaron Yusuf
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
| | - Vishal Jasani
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
| | - Nirvair Kaur
- Shiyana Eliyas BDS, MFDS, MRD, FDS (Rest Dent), PhD Consultant in Restorative Dentistry, St George's University Hospitals NHS Foundation Trust, London, UK
- Kewal Shah BDS, MFDS, MEndo. Endodontic Specialist and Clinical Teacher in Endodontics, King's College London, London, UK
- Nalin Dhamecha BDS Speciality Doctor in Endodontics, St George's University Hospitals NHS Foundation Trust, London, UK
- Tapasya Jayaram BDS Dentist with Enhanced Skills in Endodontics, Green Dental Care, London, UK
- Aaron Yusuf BDS Dentist with Enhanced Skills in Endodontics, Ridgway Dental, London, UK
- Vishal Jasani BDS Dentist with Enhanced Skills in Endodontics, Malden Dental Care, London, UK
- Nirvair Kaur BDS Specialist in Endodontics, Bupa Dental Marylebone, London, UK
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Bots-VantSpijker PC, van der Maarel-Wierink CD, Schols JMGA, Bruers JJM. Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study. PLoS One 2021; 16:e0257561. [PMID: 34559825 PMCID: PMC8462729 DOI: 10.1371/journal.pone.0257561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the oral health of older people who visit the community dental practice from both the dentists' and the patients' perspective. MATERIALS AND METHODS In this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI]. Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman's rank correlation coefficient (rho) and an ordinal regression model. RESULTS In total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis. Older people's assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication. CONCLUSIONS AND CLINICAL RELEVANCE Chronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health. Older patients themselves assess their oral health differently, mostly more positive, than their dentist.
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Affiliation(s)
- Pieternella C. Bots-VantSpijker
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology, Bunnik, The Netherlands
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Claar D. van der Maarel-Wierink
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology, Bunnik, The Netherlands
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Jos M. G. A. Schols
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology, Bunnik, The Netherlands
- Caphri/Department of Family Medicine and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Josef J. M. Bruers
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology, Bunnik, The Netherlands
- Department of Oral Public Health (OPH), Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
- Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
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Plascencia H, Díaz M, Ordinola-Zapata R, Vázquez-Sánchez ME, Juárez-Broon N, Ruíz-Gutiérrez A, Gascón G, Cruz A. Intra- and Interobserver Agreement during the Assessment of the Different Stages of Root Development Using 4 Radiographic Classifications. J Endod 2021; 47:906-913. [PMID: 33705830 DOI: 10.1016/j.joen.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/18/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study analyzed intra- and interobserver agreements during radiographic assessment of the different stages of root development using the dichotomous, Moorrees, Demirjian, and Cvek classifications, as well as the effect of the observer's level of experience on the result. METHODS Two hundred eighty-five digital periapical radiographs were examined via visual inspection by 3 experienced and 3 nonexperienced observers (n = 6) under strict technological and viewing conditions. After observer calibration, determination of the presence or absence of an open apex and the assignment of a root development stage according to the different subdivisions of the 4 indexes were performed. This evaluation was carried out by each observer in duplicate in the first round (n = 8) and repeated in the second round (n = 8). The 16 examinations performed by each observer (N = 96) were analyzed to determine the percentage of concordance followed by intraobserver, interobserver, and global observer agreement using the kappa coefficient and a weighted kappa. Additionally, to determine the level of concordance between the visual determination of an open or closed apex and the apical foramen width measured in millimeters, a dichotomized kappa coefficient was applied. RESULTS A good level of global observer agreement was found for the dichotomous, Demirjian, and Cvek classifications. However, a significantly low percentage of total concordance and global observer agreement (6.66% and 0.498, respectively) was obtained using the Moorrees classification, which was more pronounced among nonexperienced observers (0.247). Apical foramen width measurements indicated the presence of 143 roots with an open apex (50.2%) and 142 with a closed apex (49.8%), and the dichotomized kappa coefficient test revealed a good level of agreement during the visual determination of an open or closed apex (range, 0.611-0.636). CONCLUSIONS The classifications of Cvek and Demirjian provided reliable results when determining the different stages of root development. In contrast, the Moorrees classification provided the lowest agreement values, with a significant negative effect among nonexperienced observers. Finally, the visual estimation of the presence (or absence) of an open apex provided a good level of concordance with the radiographic apical foramen width.
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Affiliation(s)
- Hugo Plascencia
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico.
| | - Mariana Díaz
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - María Eugenia Vázquez-Sánchez
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Norberto Juárez-Broon
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Aloysia Ruíz-Gutiérrez
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Gerardo Gascón
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Alvaro Cruz
- Research Institute in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
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Eliyas S, Briggs PFA, Gallagher JE. Assessing a training programme for primary care dental practitioners in endodontics of moderate complexity: Pilot data on skills enhancement and treatment outcomes. Br Dent J 2018; 225:617-628. [PMID: 30310203 DOI: 10.1038/sj.bdj.2018.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/09/2022]
Abstract
Aims To explore the impact of dedicated training to extend the skills of primary care practitioners on the quality of endodontic care, using clinical, radiographic and patient-related outcomes. Methods The quality of endodontic treatment performed at the beginning and end of training to become dentists with extended skills (DES) in endodontics was assessed in vitro and in vivo from endo-training blocks and self-reported logbooks containing clinical notes and radiographs respectively. The quality of endodontic care delivered by DES post-training was measured using clinical and radiographic outcomes. Patient-related outcomes were assessed using a self-report questionnaire, including the Oral Health Impact Profile – Endodontic Outcome Measure (OHIP-EOM). Results Data on eight dentists were examined pre-and post-training, five of whom participated in further follow-up investigations on the quality of endodontic care delivered to their patients. Significant improvements in skills were seen for all domains in vitro (p <0.05), and for all domains of the clinical treatment process, and achieving the correct working length of the root filling as seen by radiography in vivo (p <0.05). The quality of the clinical process was maintained following training. Positive patient outcome (OHIP-EOM) scores were recorded (mean score of 34.72, SD = 10.74, n = 120 pre-treatment and 25.85, SD = 7.74, n = 47 representing reduced impact at follow-up). The majority of patients reported being satisfied, or very satisfied, with the service they received (72.5%, n = 98); would use the service again (68.1%, n = 92); and would recommend the service to friends and family (74.8%, n = 101). Conclusions Findings suggest that training for dentists working in practice can be successful in enhancing skills and changing practice, with evidence of high patient satisfaction and good clinical and patient-related outcomes. Pilot results must be interpreted with caution and further research is required.
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Affiliation(s)
- S Eliyas
- St George's University Hospital's NHS Foundation Trust and Hodsoll House Specialist Practice, Kent
| | - P F A Briggs
- Barts Health NHS Trust, Whitechapel, London, UK.,Health Education England London and South East, Stewart House, Russell Square London, UK
| | - J E Gallagher
- King's College London Dental Institute, Population and Patient Health Division, London, UK
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Eliyas S, Briggs PFA, Newton JT, Gallagher JE. Feasibility of assessing training of primary care dental practitioners in endodontics of moderate complexity: mapping process and learning. Br Dent J 2018; 225:325-334. [PMID: 30141484 DOI: 10.1038/sj.bdj.2018.644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/28/2022]
Abstract
Objectives To explore the feasibility of measuring quality of endodontic care provided by general dental practitioners (GDPs), using clinical, radiographic and patient-related outcomes, as well as understanding practitioner views and estimating financial costs. Methods Multi-faceted mixed-methods two-part study involving retrospective analysis of the educational component (course assessments, endodontic training blocks and analysis of a sample of teeth treated at the beginning and end of training), and prospective analysis of patients treated by these dentists after completion of training. Participant Dentists working in and patients treated in primary dental care in London. Intervention Twenty-four-month training in endodontics. Comparison Dentists enrolled in the training at different time points. Outcome Measuring outcome of endodontic treatment. Results Eight dentists (mean 36 years, SD = 8.2 years) participated in training. Subsequently, five of these dentists (mean 34.2 years, SD = 7.08 years) contributed to the prospective study and recruited 135 patients. Thirty-five patients completed all patient-related outcome questionnaires, and of these there were 16 cases with complete clinical and radiographic data (12%) at follow-up (10.1–36.4 months). Preliminary analysis revealed that a minimum of 45 cases of complete data would be required for multivariate analysis, requiring the recruitment of in excess of 375 patients to future studies to account for this level of loss to follow-up. Conclusions Findings suggest it is possible to carry out mixed-methods and treatment-related outcome-based research in primary care. Measurement/data capture tools developed were tested and used successfully in measuring the adherence to treatment processes and outcome of endodontic treatment.
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Affiliation(s)
- S Eliyas
- St George's University Hospital's NHS Foundation Trust and Hodsoll House Specialist Practice, Kent, UK
| | - P F A Briggs
- Barts Health NHS Trust, Whitechapel, London, UK.,Health Education England London and South East, Stewart House, Russell Square London, UK
| | - J T Newton
- King's College London Dental Institute, Population and Patient Health Division, London, UK
| | - J E Gallagher
- King's College London Dental Institute, Population and Patient Health Division, London, UK
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Hamid HR, Gluskin AH, Peters OA, Peters CI. Rotary Versus Reciprocation Root Canal Preparation: Initial Clinical Quality Assessment in a Novice Clinician Cohort. J Endod 2018; 44:1257-1262. [PMID: 29935868 DOI: 10.1016/j.joen.2018.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Reports comparing clinical outcomes using nickel-titanium (NiTi) reciprocating instruments with other instrumentation modalities are scarce. This study examined initial shaping outcomes after an instrumentation change of root canal instrumentation technique in a doctor of dental surgery educational program. Student characteristics, faculty/student ratio, facility, and overall endodontic treatment guidelines remained unchanged. METHODS A total of 200 nonsurgical initial molar root canal treatments completed by third-year dental students were evaluated. The cases were examined regarding the number of treatment appointments, access cavity preparation, canal taper, canal transportation, perforations, missed canals, presence of ledges, fractured instruments, obturation length, obturation quality, and sealer extrusion. Two independent evaluators determined the number of appointments per case; 4 independent and blinded evaluators analyzed radiographs at 4 treatment stages: preoperative situation, working length, cone fit, and obturation. RESULTS The following factors were significantly different between the 2 cohorts: the number of appointments, preparation length, taper, and occurrence of ledges. The WaveOne (Dentsply Sirona, York, PA) cohort had a significantly reduced treatment time compared with hand/GT rotary instrumentation (Dentsply Tulsa Dental, Tulsa, OK) (average of 3.3 vs 4.3 appointments). Appropriate length control and adequate taper were significantly more frequent in the WaveOne group. The frequency of ledges was significantly larger in the hybrid group. Other variables, such as access cavity preparation, canal transportation, perforations, missed canals, fractured instruments, obturation quality, and sealer extrusion, were statistically similar between the 2 groups. CONCLUSIONS NiTi reciprocation instrumentation was superior to hybrid hand/NiTi rotary instrumentation in reducing both patient appointments and the incidence of ledging and in improving obturation length and taper in a dental student clinic setting.
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Affiliation(s)
- Hamid R Hamid
- Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California
| | - Alan H Gluskin
- Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California
| | - Ove A Peters
- Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California; University of Queensland Dental School, UQ Oral Health Center, Herston, Queensland, Australia
| | - Christine I Peters
- Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California; University of Queensland Dental School, UQ Oral Health Center, Herston, Queensland, Australia.
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