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James P, Harding M, Beecher T, Parnell C, Browne D, Tuohy M, Kavanagh D, O'Mullane D, Guiney H, Cronin M, Whelton H. Fluoride And Caring for Children's Teeth (FACCT): Clinical Fieldwork Protocol. HRB Open Res 2018; 1:4. [PMID: 32002500 PMCID: PMC6973526 DOI: 10.12688/hrbopenres.12799.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/05/2022] Open
Abstract
Background: The reduction in dental caries seen between Irish national surveys of children’s oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis. To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children’s Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board. Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002). Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires. The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean’s Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.
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Affiliation(s)
- Patrice James
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Mairead Harding
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland.,Cork University Dental School and Hospital, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Tara Beecher
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Carmel Parnell
- Louth Meath Dental Service, Health Service Executive , Navan, Co. Meath, C15RK7Y, Ireland
| | - Deirdre Browne
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Marie Tuohy
- National Oral Health Office, St. Joseph's Hospital, Mulgrave Street, Limerick, Co. Limerick, V94C8DV, Ireland.,South Tipperary, Carlow and Kilkenny Health Service Executive Dental Service, Clonmel Community Care, Clonmel, Co. Tipperary, E91HT96, Ireland
| | - Dympna Kavanagh
- Community Pharmacy, Dental, Optical and Aural Policy Section, Department of Health, Dublin, Co. Dublin, DO2VW90, Ireland
| | - Denis O'Mullane
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Helena Guiney
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Michael Cronin
- School of Mathematical Sciences, University College Cork, Cork, Co. Cork, T12YN60, Ireland
| | - Helen Whelton
- College of Medicine and Health, University College Cork, Cork, Co. Cork, T12EDK0, Ireland
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James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev 2017; 3:CD008676. [PMID: 28362061 PMCID: PMC6464488 DOI: 10.1002/14651858.cd008676.pub2] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dental plaque associated gingivitis is a reversible inflammatory condition caused by accumulation and persistence of microbial biofilms (dental plaque) on the teeth. It is characterised by redness and swelling of the gingivae (gums) and a tendency for the gingivae to bleed easily. In susceptible individuals, gingivitis may lead to periodontitis and loss of the soft tissue and bony support for the tooth. It is thought that chlorhexidine mouthrinse may reduce the build-up of plaque thereby reducing gingivitis. OBJECTIVES To assess the effectiveness of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for the control of gingivitis and plaque compared to mechanical oral hygiene procedures alone or mechanical oral hygiene procedures plus placebo/control mouthrinse. Mechanical oral hygiene procedures were toothbrushing with/without the use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment.To determine whether the effect of chlorhexidine mouthrinse is influenced by chlorhexidine concentration, or frequency of rinsing (once/day versus twice/day).To report and describe any adverse effects associated with chlorhexidine mouthrinse use from included trials. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 28 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 28 September 2016); MEDLINE Ovid (1946 to 28 September 2016); Embase Ovid (1980 to 28 September 2016); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 28 September 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials assessing the effects of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for at least 4 weeks on gingivitis in children and adults. Mechanical oral hygiene procedures were toothbrushing with/without use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. We included trials where participants had gingivitis or periodontitis, where participants were healthy and where some or all participants had medical conditions or special care needs. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference (MD) and 95% confidence interval (CI). We combined MDs where studies used the same scale and standardised mean differences (SMDs) where studies used different scales. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. Due to anticipated heterogeneity we used random-effects models for all meta-analyses. MAIN RESULTS We included 51 studies that analysed a total of 5345 participants. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however, this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Gingivitis After 4 to 6 weeks of use, chlorhexidine mouthrinse reduced gingivitis (Gingival Index (GI) 0 to 3 scale) by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse (10 trials, 805 participants with mild gingival inflammation (mean score 1 on the GI scale) analysed, high-quality evidence). A similar effect size was found for reducing gingivitis at 6 months. There were insufficient data to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 (moderate or severe levels of gingival inflammation). Plaque Plaque was measured by different indices and the SMD at 4 to 6 weeks was 1.45 (95% CI 1.00 to 1.90) standard deviations lower in the chlorhexidine group (12 trials, 950 participants analysed, high-quality evidence), indicating a large reduction in plaque. A similar large reduction was found for chlorhexidine mouthrinse use at 6 months. Extrinsic tooth staining There was a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 4 to 6 weeks. The SMD was 1.07 (95% CI 0.80 to 1.34) standard deviations higher (eight trials, 415 participants analysed, moderate-quality evidence) in the chlorhexidine mouthrinse group. There was also a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 7 to 12 weeks and 6 months. Calculus Results for the effect of chlorhexidine mouthrinse on calculus formation were inconclusive. Effect of concentration and frequency of rinsing There were insufficient data to determine whether there was a difference in effect for either chlorhexidine concentration or frequency of rinsing. Other adverse effects The adverse effects most commonly reported in the included studies were taste disturbance/alteration (reported in 11 studies), effects on the oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions (reported in 13 studies) and a general burning sensation or a burning tongue or both (reported in nine studies). AUTHORS' CONCLUSIONS There is high-quality evidence from studies that reported the Löe and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies.
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Affiliation(s)
- Patrice James
- Oral Health Services Research Centre, Cork University Dental School and Hospital, Wilton, Cork, Ireland
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, JR Moore Building, Oxford Road, Manchester, UK, M13 9PL
| | - Carmel Parnell
- HSE Louth Meath Dental Service, Our Lady's Hospital, Navan, Co Meath, Ireland
| | - Mairead Harding
- Oral Health Services Research Centre, Cork University Dental School and Hospital (UCC), Wilton, Cork, and HSE South (CHO 4), Cork, Ireland
| | - Thomas Lamont
- Dundee Dental School, University of Dundee, Park Place, Dundee, Tayside, UK, DD1 4HN
| | - Andrea Cheung
- Cork University Dental School and Hospital (UCC), Wilton, Cork, Ireland
| | - Helen Whelton
- School of Dentistry, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK, LS2 9JT
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, JR Moore Building, Oxford Road, Manchester, UK, M13 9PL
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Parnell C, O'Mullane D. After-Brush Rinsing Protocols, Frequency of Toothpaste Use: Fluoride and Other Active Ingredients. Monographs in Oral Science 2013; 23:140-53. [DOI: 10.1159/000350480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Parnell C. Oral health policy--time to broaden our perspective? J Ir Dent Assoc 2012; 58:S20-S24. [PMID: 22888575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Carmel Parnell
- Oral Health Services Research Centre and HSE Meath, Oral Health Services Research Centre, University Dental School, Wilton, Cork.
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Parnell C, Gugnani N, Sherriff A, James P, Beirne PV. Non-fluoride topical remineralising agents containing calcium and/or phosphate for controlling dental caries. Hippokratia 2012. [DOI: 10.1002/14651858.cd009732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carmel Parnell
- Cork University Dental School; Oral Health Services Research Centre; Wilton Cork Ireland
- HSE Dublin North East; Meath Dental Services Ireland
| | - Neeraj Gugnani
- DAV (C) Dental College; Department of Pediatric Dentistry; Model Town YamunaNagar 135001 Haryana India
| | - Andrea Sherriff
- University of Glasgow Dental School; Department of Dental Public Health; 378 Sauchiehall Street Glasgow UK G2 3JZ
- University of Glasgow; College of Medicine, Veterinary and Life Sciences; Glasgow UK
| | - Patrice James
- Cork University Dental School; Oral Health Services Research Centre; Wilton Cork Ireland
| | - Paul V Beirne
- University College Cork; Department of Epidemiology and Public Health; Brookfield Health Sciences Complex College Road Cork Ireland
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O’Mullane D, James P, Whelton H, Parnell C. Methodological issues in oral health research: intervention studies. Community Dent Oral Epidemiol 2012; 40 Suppl 1:15-20. [DOI: 10.1111/j.1600-0528.2011.00661.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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O'Mullane D, Parnell C. Early childhood caries: a complex problem requiring a complex intervention. Community Dent Health 2011; 28:254. [PMID: 22320060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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James P, Parnell C, Whelton H. The caries-preventive effect of chlorhexidine varnish in children and adolescents: a systematic review. Caries Res 2010; 44:333-40. [PMID: 20606432 DOI: 10.1159/000315346] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 05/20/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS Our purpose was to systematically review the literature on the effectiveness of chlorhexidine varnish for preventing dental caries in children and adolescents and to determine its effectiveness compared to fluoride varnish. METHODS MEDLINE, EMBASE and the Cochrane Library were searched through December 2009 to identify relevant randomised trials with blind outcome assessment and a minimum duration of 1 year. The search was later updated in MEDLINE and the Cochrane Library to March 19th, 2010. Risk of bias of the included trials was assessed. The primary outcome was the caries increment. RESULTS Twelve trials met the inclusion criteria for the review. There was considerable variation between trials in the concentration and frequency of application of the chlorhexidine varnish, in baseline caries levels and in background exposure to fluoride. Six parallel-group trials reported no statistically significant difference in caries increment in permanent teeth with the application of chlorhexidine varnish compared to placebo or no treatment. The results of 4 split-mouth trials were conflicting: 2 trials found no significant difference in caries increment and 2 reported statistically significant results in favour of chlorhexidine varnish. One trial of the effect of chlorhexidine varnish in primary teeth demonstrated a statistically significant reduction in caries increment. The results of 1 trial comparing chlorhexidine varnish with fluoride varnish for preventing caries in adolescents were equivocal. CONCLUSION Evidence regarding the effectiveness of chlorhexidine varnish for preventing caries is inconclusive. Further well-conducted randomised trials are required before chlorhexidine varnish can be recommended for caries prevention.
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Affiliation(s)
- Patrice James
- Oral Health Services Research Centre, Cork University Dental School and Hospital, Wilton, Cork, Ireland.
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Parnell C, James P, Whelton H. S53– Challenges to developing guidelines for a public dental service. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.04.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
OBJECTIVE To determine whether the conduct of the second stage of labor and delivery technique influences the incidence of rupture of the anal sphincter. MATERIAL AND METHOD A total of 1072 primipara delivered vaginally at term at Rigshospitalet in 1998. A questionnaire on prenatal risk factors, conduct of the second stage of labor, and delivery technique was completed by the attending midwife immediately after delivery in 90 cases with rupture of the sphincter and in two subsequent controls (n = 164), matched by use of vacuum extractor and episiotomy. RESULTS Partial or total sphincter rupture was found in 8.4% of primipara who delivered vaginally, in 20.9% of those delivered by vacuum extraction, and in 6.4% of those with episiotomy only. The prenatal risk factors--maternal age, birth weight, shoulder dystocia, and edema of the perineum were found to have a statistically significant effect on the incidence of rupture of the sphincter ani. In non-instrumental vaginal deliveries easing of the perineum over the caput as it advanced helped prevent a rupture of the anal sphincter. Vacuum extraction performed with the woman in a semi-recumbant position was associated with an increased risk of rupture of the anal sphincter, whereas attention to the perineum during extraction decreased the risk. CONCLUSIONS The significant effect of prenatal risk factors did not explain a correlation between delivery technique and rupture of the sphincter ani. The present study indicates that a reduction in the incidence of sphincter rupture may be accomplished by improved obstetric care: fewer vacuum extractions and improved delivery technique.
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Affiliation(s)
- C Parnell
- Obstetric Department, Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark.
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Abstract
BACKGROUND Pushing in the second stage of labor can be forced or follow the spontaneous urge to bear down. Recent studies have shown that spontaneous pushing results in a longer second stage, fewer CTG changes, higher arterial pH and less damage to the birth canal. METHOD Randomized trial of spontaneous vs. forced pushing in 350 primiparous women. RESULTS There was no difference between the randomized groups in duration of second stage of labor, umbilical arterial pH or damage to the birth canal. Of the women allotted to spontaneous pushing, 65.6% used the closed glottis technique for more than half the expulsive phase. When dividing the women into two groups according to the actual pushing technique used most, open or closed glottis, it turned out that women who used the open glottis technique had a shorter second stage of labor and gave birth to infants with lower birth weight. CONCLUSION Recommending of spontaneous bearing down during the expulsive phase of labor did not result in a significant difference in duration of the second stage of labor, fetal arterial pH or less damage to the birth canal. Women who chose the open glottis technique had a shorter expulsive phase and gave birth to smaller infants than those who used the closed glottis technique.
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Affiliation(s)
- C Parnell
- Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark
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Parnell C. 'Self-assessment manual of standards'. Br Dent J 1991; 171:307. [PMID: 1742100 DOI: 10.1038/sj.bdj.4807699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Nickelsen C, Weber T, Parnell C, Nim J, Kemp AM, Junge I. [Cardiotocographic monitoring of deliveries. A prospective comparative study of 2 types of electrodes]. Ugeskr Laeger 1989; 151:440-2. [PMID: 2919468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The number of electrodes employed, the frequency of reapplication, the technical quality of monitoring and the complications of use of spiral electrodes and Copeland electrodes for cardiotocographic monitoring of deliveries are assessed in a prospective randomized investigation. The number of electrodes employed and the frequency of reapplications were significantly lower employing Copeland electrodes. Similarly, the electrode signal was significantly better as assessed by the percentage of the duration of monitoring in which the cardiotocogram did not register during the second stage of labour on account of poor electrode signals. No differences were found in the frequencies of complications or subjective discomfort in the mother on employing the two types of electrodes.
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