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Walsh T, Macey R, Ricketts D, Carrasco Labra A, Worthington H, Sutton A, Freeman S, Glenny A, Riley P, Clarkson J, Cerullo E. Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews. J Dent Res 2022; 101:261-269. [PMID: 34636266 PMCID: PMC8864327 DOI: 10.1177/00220345211042795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Detection and diagnosis of caries-typically undertaken through a visual-tactile examination, often with supporting radiographic investigations-is commonly regarded as being broadly effective at detecting caries that has progressed into dentine and reached a threshold where restoration is necessary. With earlier detection comes an opportunity to stabilize disease or even remineralize the tooth surface, maximizing retention of tooth tissue and preventing a lifelong cycle of restoration. We undertook a formal comparative analysis of the diagnostic accuracy of different technologies to detect and inform the diagnosis of early caries using published Cochrane systematic reviews. Forming the basis of our comparative analysis were 5 Cochrane diagnostic test accuracy systematic reviews evaluating fluorescence, visual or visual-tactile classification systems, imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies. Acceptable reference standards included histology, operative exploration, or enhanced visual assessment (with or without tooth separation) as appropriate. We conducted 2 analyses based on study design: a fully within-study, within-person analysis and a network meta-analysis based on direct and indirect comparisons. Nineteen studies provided data for the fully within-person analysis and 64 studies for the network meta-analysis. Of the 5 technologies evaluated, the greatest pairwise differences were observed in summary sensitivity points for imaging and all other technologies, but summary specificity points were broadly similar. For both analyses, the wide 95% prediction intervals indicated the uncertainty of future diagnostic accuracy across all technologies. The certainty of evidence was low, downgraded for study limitations, inconsistency, and indirectness. Summary estimates of diagnostic accuracy for most technologies indicate that the degree of certitude with which a decision is made regarding the presence or absence of disease may be enhanced with the use of such devices. However, given the broad prediction intervals, it is challenging to predict their accuracy in any future "real world" context.
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Affiliation(s)
- T. Walsh
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK,T. Walsh, Division of Dentistry, School of
Medical Sciences, The University of Manchester, Coupland 3 Building, Manchester
M13 9PL, UK.
| | - R. Macey
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - D. Ricketts
- Dundee Dental School, University of
Dundee, Dundee, UK
| | - A. Carrasco Labra
- Department of Evidence Synthesis and
Translation Research, Science and Research Institute, LLC, American Dental
Association, Chicago, IL, USA,Department of Oral and Craniofacial
Health Science, School of Dentistry, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
| | - H. Worthington
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - A.J. Sutton
- Department of Health Sciences,
University of Leicester, Leicester, UK
| | - S. Freeman
- Department of Health Sciences,
University of Leicester, Leicester, UK
| | - A.M. Glenny
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - P. Riley
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK
| | - J. Clarkson
- Division of Dentistry, School of
Medical Sciences, The University of Manchester, Manchester, UK,Dundee Dental School, University of
Dundee, Dundee, UK
| | - E. Cerullo
- Department of Health Sciences,
University of Leicester, Leicester, UK
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2
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Abstract
The objectives of this study were to assess the reporting quality and methodological quality of split-mouth trials (SMTs) published during the past 2 decades and to determine whether there has been an improvement in their quality over time. We searched the MEDLINE database via PubMed to identify SMTs published in 1998, 2008, and 2018. For each included SMT, we used the CONsolidated Standards Of Reporting Trials (CONSORT) 2010 guideline, CONSORT for within-person trial (WPT) extension, and a new 3-item checklist to assess its trial reporting quality (TRQ), WPT-specific reporting quality (WRQ), and SMT-specific methodological quality (SMQ), respectively. Multivariable generalized linear models were performed to analyze the quality of SMTs over time, adjusting for potential confounding factors. A total of 119 SMTs were included. The mean overall score for the TRQ (score range, 0 to 32), WRQ (0 to 15), and SMQ (0 to 3) was 15.77 (SD 4.51), 6.06 (2.06), and 1.12 (0.70), respectively. The primary outcome was clearly defined in only 28 SMTs (23.5%), and only 27 (22.7%) presented a replicable sample size calculation. Only 45 SMTs (37.8%) provided the rationale for using a split-mouth design. The correlation between body sites was reported in only 5 studies (4.2%) for sample size calculation and 4 studies (3.4%) for statistical results. Only 2 studies (1.7%) performed an appropriate sample size calculation, and 46 (38.7%) chose appropriate statistical methods, both accounting for the correlation among treatment groups and the clustering/multiplicity of measurements within an individual. Results of regression analyses suggested that the TRQ of SMTs improved significantly with time ( P < 0.001), while there was no evidence of improvement in WRQ or SMQ. Both the reporting quality and methodological quality of SMTs still have much room for improvement. Concerted efforts are needed to improve the execution and reporting of SMTs.
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Affiliation(s)
- D. Qin
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - F. Hua
- Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - H. He
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - S. Liang
- Hubei-MOST KLOS & KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - H. Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - T. Walsh
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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3
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Abstract
Background Recent years have seen numerous efforts and resources devoted to the development of open access (OA), but the current OA situation of the oncology literature remains unknown. We conducted this cross-sectional study to determine the current share and provision methods of OA in the field of oncology, identify predictors of OA status (OA versus non-OA), and study the association between OA and citation counts. Materials and methods PubMed was searched for oncology-related, peer-reviewed journal articles published in December 2014. Google, Google Scholar, PubMed, ResearchGate, OpenDOAR and OAIster were manually checked to assess the OA status of each included article. Citation data were extracted from Web of Science, Scopus and Google Scholar. Descriptive statistics were used to summarize the OA proportion (primary outcome) and OA provision methods. Multivariable logistic regression and multilevel generalized linear model analyses were performed to study predictors of OA status and the association between OA and citation counts, respectively. Results In a random sample of 1000 articles, 912 were deemed eligible and therefore included. Of these, the full-texts of 530 articles (58.1%; 95% CI: 54.9-61.3) were freely available online: 314 (34.4%) were available from publishers ('Gold road' to OA), 424 (46.5%) were available via self-archiving ('Green road' to OA). According to multivariable regression analyses, impact factor, publisher type, language, research type, number of authors, continent of origin, and country income were significant predictors of articles' OA status; OA articles received a citation rate 1.24 times the incidence rate for non-OA articles (95% CI: 1.05-1.47; P = 0.012). Conclusions Based on our sample, in the field of oncology, 42% of recent journal articles are behind the pay-wall (non-OA) 1 year after publication; the 'Green road' of providing OA is more common than the 'Gold road'; OA is associated with higher citation counts.
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Affiliation(s)
- F Hua
- Cochrane Oral Health, Divisions of Dentistry
| | - H Sun
- Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - T Walsh
- Cochrane Oral Health, Divisions of Dentistry
| | - A-M Glenny
- Cochrane Oral Health, Divisions of Dentistry
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4
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Persson M, Sandy JR, Waylen A, Wills AK, Al-Ghatam R, Ireland AJ, Hall AJ, Hollingworth W, Jones T, Peters TJ, Preston R, Sell D, Smallridge J, Worthington H, Ness AR. A cross-sectional survey of 5-year-old children with non-syndromic unilateral cleft lip and palate: the Cleft Care UK study. Part 1: background and methodology. Orthod Craniofac Res 2018; 18 Suppl 2:1-13. [PMID: 26567851 PMCID: PMC4670715 DOI: 10.1111/ocr.12104] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 08/30/2015] [Indexed: 11/28/2022]
Abstract
Objectives We describe the methodology for a major study investigating the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after an initial survey, detailed in the Clinical Standards Advisory Group (CSAG) report in 1998, had informed government recommendations on centralization. Setting and Sample Population This is a UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Children born between 1 April 2005 and 31 March 2007 were seen in cleft centre audit clinics. Materials and Methods Consent was obtained for the collection of routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) and anthropometric measures (height, weight, head circumference). The methodology for each clinical measure followed those of the earlier survey as closely as possible. Results We identified 359 eligible children and recruited 268 (74.7%) to the study. Eleven separate records for each child were collected at the audit clinics. In total, 2666 (90.4%) were collected from a potential 2948 records. The response rates for the self-reported questionnaires, completed at home, were 52.6% for the Health and Lifestyle Questionnaire and 52.2% for the Satisfaction with Service Questionnaire. Conclusions Response rates and measures were similar to those achieved in the previous survey. There are practical, administrative and methodological challenges in repeating cross-sectional surveys 15 years apart and producing comparable data.
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Affiliation(s)
- M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - R Al-Ghatam
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,Dental & Maxillofacial Centre, Royal Medical Services, West Riffa, Kingdom of Bahrain
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Centre for Child & Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - W Hollingworth
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - T Jones
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,Musgrove Park Hospital, Taunton, UK
| | - T J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - R Preston
- Cleft Lip and Palate Association, London, UK
| | - D Sell
- Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK.,Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - H Worthington
- School of Dentistry, University of Manchester, Manchester, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
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5
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O’Neill C, Worthington H, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Tickle M. Cost-Effectiveness of Caries Prevention in Practice: A Randomized Controlled Trial. J Dent Res 2017; 96:875-880. [DOI: 10.1177/0022034517708968] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 2-arm parallel-group randomized controlled trial measured the cost-effectiveness of caries prevention in caries-free children aged 2 to 3 y attending general practice. The setting was 22 dental practices in Northern Ireland. Participants were centrally randomized into intervention (22,600 ppm fluoride varnish, toothbrush, a 50-mL tube of 1,450 ppm fluoride toothpaste, and standardized prevention advice) and control (advice only), both provided at 6-monthly intervals during a 3-y follow-up. The primary outcome measure was conversion from caries-free to caries-active states assessed by calibrated and blinded examiners; secondary outcome measures included decayed, missing, or filled teeth surfaces (dmfs); pain; and extraction. Cumulative costs were related to each of the trial’s outcomes in a series of incremental cost effectiveness ratios (ICERs). Sensitivity analyses examined the impact of using dentist’s time as measured by observation rather than that reported by the dentist. The costs of applying topical fluoride were also estimated assuming the work was undertaken by dental nurses or hygienists rather than dentists. A total of 1,248 children (624 randomized to each group) were recruited, and 1,096 (549 in the intervention group and 547 in the control group) were included in the final analyses. The mean difference in direct health care costs between groups was £107.53 (£155.74 intervention, £48.21 control, P < 0.05) per child. When all health care costs were compared, the intervention group’s mean cost was £212.56 more than the control group (£987.53 intervention, £774.97 control, P < 0.05). Statistically significant differences in outcomes were only detected with respect to carious surfaces. The mean cost per carious surface avoided was estimated at £251 (95% confidence interval, £454.39–£79.52). Sensitivity analyses did not materially affect the study’s findings. This trial raises concerns about the cost-effectiveness of a fluoride-based intervention delivered at the practice level in the context of a state-funded dental service (EudraCT No: 2009-010725-39; ISRCTN: ISRCTN36180119).
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Affiliation(s)
- C. O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - H.V. Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M. Donaldson
- Health & Social Care Board of Northern Ireland, Belfast, UK
| | - S. Birch
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Health Economics and Policy Analysis, McMaster University, Ontario, Canada
| | - S. Noble
- Northern Health & Social Care Trust, Antrim, UK
| | | | - L. Murphy
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - M. Greer
- hVIVO, Queen Mary BioEnterprises Innovation Centre, London, UK
| | - J. Brodison
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - R. Verghis
- Northern Ireland Clinical Trials Unit, Belfast Health & Social Care Trust, Belfast, UK
| | - M. Tickle
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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6
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Abstract
The objectives of this study were 1) to find out if and how authors and peer reviewers for dental journals are encouraged to use reporting guidelines (RGs); 2) to identify factors related to RG endorsement; and 3) to assess the knowledge, opinions, and future plans of dental journal editors in chief (EICs) on RGs. A total of 109 peer-reviewed and original research-oriented dental journals that were indexed in the MEDLINE and/or SCIE database in 2015 were included. The "instructions to authors" and "instructions to reviewers" of these journals were identified and retrieved from journals' official websites. Any mention of RGs or other related policies were sought and extracted. In addition, an anonymous survey of the EICs of the included journals was conducted with a validated questionnaire. All 109 journals provided "instructions to authors," among which 55 (50.5%) mentioned RGs. Only the CONSORT (45.0%), PRISMA (13.8%), and STROBE (12.8%) guidelines were mentioned by >10% of the included journals. Statistical analyses suggest that RGs were more frequently mentioned by SCIE-indexed journals (P < 0.001), higher-impact journals (P = 0.002), and journals that endorsed the ICMJE recommendations (P < 0.001). "Instructions to reviewers" were available online for only 9 journals (8.3%), 3 of which mentioned RGs. For the EIC survey, the response rate was 32.1% (35 of 109). Twenty-six editors (74.3%) stated that they knew what RGs were before receiving our questionnaire. Twenty-four editors (68.6%) believed that RGs should be adopted by all refereed dental journals where appropriate. RGs are important tools for enhancing research reporting and reducing avoidable research waste, but currently they are not widely endorsed by dental journals. Joint efforts by all stakeholders to further promote RG usage in dentistry are needed.
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Affiliation(s)
- F Hua
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
| | - T Walsh
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
| | - A-M Glenny
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
| | - H Worthington
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Manchester, UK
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7
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Bailey E, Worthington H, Coulthard P. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth, a Cochrane systematic review. Br Dent J 2016; 216:451-5. [PMID: 24762895 DOI: 10.1038/sj.bdj.2014.330] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 11/09/2022]
Abstract
This paper compares the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth. In this systematic review only randomised controlled double-blinded clinical trials were included. We calculated the proportion of patients with at least 50% pain relief at 2 and 6 hours post dosing, along with the proportion of participants using rescue medication at 6 and 8 hours. Adverse events were also analysed. Data was meta-analysed where possible. Seven studies were included with a total of 2,241 participants enrolled. Ibuprofen 400 mg is superior to 1,000 mg paracetamol with a risk ratio for at least 50% pain relief at 6 hours of 1.47 (95% confidence interval [CI] 1.28 to 1.69). For the combined drug, the risk ratio for at least 50% maximum pain relief over 6 hours is 1.77 (95% CI 1.32 to 2.39) based on total pain relief (TOTPAR) data. There is high quality evidence that ibuprofen is superior to paracetamol. The novel combination drug shows encouraging results when compared to the single drugs (based on two trials).
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Affiliation(s)
- E Bailey
- University of Manchester, School of Dentistry, Higher Cambridge Street, Manchester, M13 9PL
| | - H Worthington
- University of Manchester, School of Dentistry, Higher Cambridge Street, Manchester, M13 9PL
| | - P Coulthard
- University of Manchester, School of Dentistry, Higher Cambridge Street, Manchester, M13 9PL
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8
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Ness AR, Waylen A, Hurley K, Jeffreys M, Penfold C, Pring M, Leary SD, Allmark C, Toms S, Ring S, Peters TJ, Hollingworth W, Worthington H, Nutting C, Fisher S, Rogers SN, Thomas SJ. Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000. Clin Otolaryngol 2016; 41:804-809. [PMID: 26436654 PMCID: PMC5111771 DOI: 10.1111/coa.12548] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A R Ness
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - K Hurley
- Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C Penfold
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Pring
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - S D Leary
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C Allmark
- National Cancer Research Institute Consumer Liaison Group (NCRI CLG), Independent Cancer Patients Voice (ICPV), London, UK
| | - S Toms
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Ring
- MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, Bristol, UK
| | - T J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H Worthington
- Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
| | - C Nutting
- Royal Marsden Hospital and the Institute for Cancer Research, London, UK
| | - S Fisher
- Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
| | - S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - S J Thomas
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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9
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Macey R, Glenny A, Walsh T, Tickle M, Worthington H, Ashley J, Brocklehurst P. The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study. J Dent Res 2015; 94:70S-78S. [PMID: 25604256 PMCID: PMC4541095 DOI: 10.1177/0022034514567335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Regularly attending adult patients are increasingly asymptomatic and not in need of treatment when attending for their routine dental examinations. As oral health improves further, using the general dental practitioner to undertake the "checkup" on regular "low-risk" patients represents a substantial and potentially unnecessary cost for state-funded systems. Given recent regulatory changes in the United Kingdom, it is now theoretically possible to delegate a range of tasks to hygiene-therapists. This has the potential to release the general dental practitioner's time and increase the capacity to care. The aim of this study is to compare the diagnostic test accuracy of hygiene-therapists when screening for dental caries and periodontal disease in regularly attending asymptomatic adults who attend for their checkup. A visual screen by hygiene-therapists acted as the index test, and the general dental practitioner acted as the reference standard. Consenting asymptomatic adult patients, who were regularly attending patients at 10 practices across the Northwest of England, entered the study. Both sets of clinicians made an assessment of dental caries and periodontal disease. The primary outcomes measured were the sensitivity and specificity values for dental caries and periodontal disease. In total, 1899 patients were screened. The summary point for sensitivity of dental care professionals when screening for caries and periodontal disease was 0.81 (95% CI, 0.74 to 0.87) and 0.89 (0.86 to 0.92), respectively. The summary point for specificity of dental care professionals when screening for caries and periodontal disease was 0.87 (0.78 to 0.92) and 0.75 (0.66 to 0.82), respectively. The results suggest that hygiene-therapists could be used to screen for dental caries and periodontal disease. This has important ramifications for service design in public-funded health systems.
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Affiliation(s)
- R Macey
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - A Glenny
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - T Walsh
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - M Tickle
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - H Worthington
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
| | - J Ashley
- General Dental Practitioner, Woodlands Dental Practice, Wirral, UK
| | - P Brocklehurst
- School of Dentistry, University of Manchester, Oxford Road, Manchester, UK
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10
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Brooks SC, Worthington H, Gonedalles T, Bobrow B, Morrison LJ. Implementation of the PulsePoint smartphone application for crowd-sourcing bystander resuscitation. Crit Care 2014. [PMCID: PMC4069540 DOI: 10.1186/cc13674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Glenny A, Gibson F, Auld E, Coulson S, Clarkson J, Craig J, Eden O, Khalid T, Worthington H, Pizer B. The development of evidence-based guidelines on mouth care for children, teenagers and young adults treated for cancer. Eur J Cancer 2010; 46:1399-412. [DOI: 10.1016/j.ejca.2010.01.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 01/04/2010] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
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12
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Needleman I, Moher D, Altman DG, Schulz KF, Moles DR, Worthington H. Improving the clarity and transparency of reporting health research: a shared obligation and responsibility. J Dent Res 2008; 87:894-5. [PMID: 18809741 DOI: 10.1177/154405910808701013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Worthington H, Olpin SE, Blumenthal I, Morris AAM. Hyperlipidaemia due to carnitine palmitoyltransferase I deficiency. J Inherit Metab Dis 2007; 30:104. [PMID: 17160614 DOI: 10.1007/s10545-006-0480-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Received: 09/26/2006] [Revised: 10/19/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
We report a patient with carnitine palmitoyltransferase I (CPT I) deficiency, who presented with acute encephalopathy at 6 months of age. This was precipitated by an episode of gastroenteritis. No hypoglycaemia was documented, but there was hepatomegaly; blood tests revealed raised transaminases, a coagulopathy and severe hypertriglyceridaemia (48.8 mmol/L) and hypercholesterolaemia (9.5 mmol/L). The hyperlipidaemia resolved within 3 days of treatment and did not recur. At 2 years of age, the patient's liver function, growth and development are all normal. Hyperlipidaemia has been reported during acute illness in previous patients with CPT I deficiency but it is not a well-recognized feature; it should alert metabolic specialists to this potential diagnosis.
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Affiliation(s)
- H Worthington
- Willink Unit, Royal Manchester Children's Hospital, Manchester, UK
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Milsom K, Blinkhorn A, Worthington H, Threlfall A, Buchanan K, Kearney-Mitchell P, Tickle M. The effectiveness of school dental screening: a cluster-randomized control trial. J Dent Res 2006; 85:924-8. [PMID: 16998133 DOI: 10.1177/154405910608501010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dental screening of children in schools is undertaken in many countries. There is no evidence that this activity is effective. The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level. A four-arm cluster-randomized controlled trial was undertaken in the northwest of England. In total, 16,864 children aged 6-9 years in 168 schools were randomly allocated to 3 test groups, which received screening according to different models, and a control, which received no intervention. There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms. School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study.
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Affiliation(s)
- K Milsom
- Halton NHS Primary Care Trust, UK
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Abstract
A multi-center study is one conducted simultaneously in several participating centers following an agreed protocol, where the randomization has been carried out independently within each center. The main consideration for pooling the data from the individual centers is the choice between a weighted analysis, which weights centers relative to the number of patients in them, or an unweighted analysis as the primary statistical method. The unweighted analysis is used to investigate whether there was an interaction between the centers and study groups. Another issue is whether a fixed- or random-effects model should be used. There is unresolved controversy among statisticians about whether to use a weighted (type II) or unweighted analysis (type III), since there are advantages and disadvantages to the use of either method. The weighted analysis provides the most powerful test of the treatment contrast if there is no interaction between treatment and center. If there is an interaction, the unweighted analysis leads to unbiased estimates. Although, from an estimation and hypothesis testing standpoint, there is no need to balance the number of patients between the sites, it is sensible to avoid major imbalances among the study sites. There is agreement among statisticians that a fixed-effects model should be used.
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Affiliation(s)
- H Worthington
- Dental Health Unit, 3A Skelton House, Manchester Science Park, Manchester M15 6SH, UK.
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Radcliffe CE, Potouridou L, Qureshi R, Habahbeh N, Qualtrough A, Worthington H, Drucker DB. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis. Int Endod J 2004; 37:438-46. [PMID: 15189432 DOI: 10.1111/j.1365-2591.2004.00752.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the resistance of microorganisms associated with refractory endodontic infections to sodium hypochlorite used as a root canal irrigant. METHODOLOGY Two strains each of Actinomyces naeslundii, Candida albicans and Enterococcus faecalis were tested as late logarithmic phase inocula, against sodium hypochlorite adjusted to 0.5, 1.0, 2.5 and 5.25% w/v. Contact times used were 0, 10, 20, 30, 60 and 120 s. In the case of E. faecalis, additional experiments used contact times of 1.0, 2.0, 5.0, 10.0 and 30.0 min. Anti-microbial action was halted by sodium thiosulphate addition. Survivors were measured primarily using viable counts on drop plates. Additionally, pour plates were used to count low colony-forming units (cfu) and dilutions to 10(-6) were used to count high cfu. RESULTS All concentrations of NaOCl lowered cfu below the limit of detection after 10 s in the case of A. naeslundii and C. albicans. However, E. faecalis proved to be more resistant to NaOCl. Using 0.5% NaOCl for 30 min reduced cfu to zero for both strains tested. This compares with 10 min for 1.0%, 5 min for 2.5% and 2 min for 5.25% (P < 0.001). Regression analysis for the dependent variable log(e)(count + 1) with log(e)(time + 1) and concentration as explanatory variables gave rise to a significant interaction between time and concentration (P < 0.001). CONCLUSION The published association of E. faecalis with refractory endodontic infection may result, at least partially, from high resistance of this species to NaOCl. This does not appear to be the case with A. naeslundii or C. albicans.
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Affiliation(s)
- C E Radcliffe
- Oral Microbiology Laboratory, University Dental Hospital of Manchester, Manchester, UK
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Radcliffe CE, Potouridou L, Qureshi R, Habahbeh N, Qualtrough A, Worthington H, Drucker DB. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis. Int Endod J 2004. [PMID: 15189432 DOI: 10.1111/j.1365–2591.2004.00752.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine the resistance of microorganisms associated with refractory endodontic infections to sodium hypochlorite used as a root canal irrigant. METHODOLOGY Two strains each of Actinomyces naeslundii, Candida albicans and Enterococcus faecalis were tested as late logarithmic phase inocula, against sodium hypochlorite adjusted to 0.5, 1.0, 2.5 and 5.25% w/v. Contact times used were 0, 10, 20, 30, 60 and 120 s. In the case of E. faecalis, additional experiments used contact times of 1.0, 2.0, 5.0, 10.0 and 30.0 min. Anti-microbial action was halted by sodium thiosulphate addition. Survivors were measured primarily using viable counts on drop plates. Additionally, pour plates were used to count low colony-forming units (cfu) and dilutions to 10(-6) were used to count high cfu. RESULTS All concentrations of NaOCl lowered cfu below the limit of detection after 10 s in the case of A. naeslundii and C. albicans. However, E. faecalis proved to be more resistant to NaOCl. Using 0.5% NaOCl for 30 min reduced cfu to zero for both strains tested. This compares with 10 min for 1.0%, 5 min for 2.5% and 2 min for 5.25% (P < 0.001). Regression analysis for the dependent variable log(e)(count + 1) with log(e)(time + 1) and concentration as explanatory variables gave rise to a significant interaction between time and concentration (P < 0.001). CONCLUSION The published association of E. faecalis with refractory endodontic infection may result, at least partially, from high resistance of this species to NaOCl. This does not appear to be the case with A. naeslundii or C. albicans.
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Affiliation(s)
- C E Radcliffe
- Oral Microbiology Laboratory, University Dental Hospital of Manchester, Manchester, UK
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Hamlet S, Ellwood R, Cullinan M, Worthington H, Palmer J, Bird P, Narayanan D, Davies R, Seymour G. Persistent colonization with Tannerella forsythensis and loss of attachment in adolescents. J Dent Res 2004; 83:232-5. [PMID: 14981125 DOI: 10.1177/154405910408300309] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Colonization with Tannerella forsythensis may characterize the conversion of periodontally healthy sites into diseased sites. This three-year study describes the prevalence of T. forsythensis and its relationship to clinical loss of attachment (LOA) in a group of adolescents considered at risk of developing early chronic periodontitis. Adolescents with (LOA+) and without (LOA-) loss of attachment were examined at baseline and 1.5 and 3 yrs subsequently. On each occasion, attachment loss was measured on selected teeth, and the presence of T. forsythensis in their subgingival plaque samples was determined by PCR. T. forsythensis prevalence in LOA+ subjects at baseline (64%) increased to 82% and 86% on subsequent examinations. In contrast, prevalence of T. forsythensis in LOA- subjects was always significantly lower (25%, 36%, and 32%, respectively). The odds of loss of attachment were 8.16 times greater in subjects infected with T. forsythensis at each examination. These results suggest that T. forsythensis is strongly associated with loss of attachment in this adolescent population.
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Affiliation(s)
- S Hamlet
- Oral Biology and Pathology, School of Dentistry, University of Queensland, St Lucia 4072, Australia.
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Deery C, Heanue M, Deacon S, Robinson PG, Walmsley AD, Worthington H, Shaw W, Glenny AM. The effectiveness of manual versus powered toothbrushes for dental health: a systematic review. J Dent 2004; 32:197-211. [PMID: 15001285 DOI: 10.1016/j.jdent.2003.11.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 11/18/2003] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare manual and powered toothbrushes in everyday use, principally in relation to plaque removal and gingival health. Stain, calculus removal, dependability, adverse effects and cost were also considered. METHOD A systematic review was undertaken in collaboration with the Cochrane Oral Health Group. Five electronic databases were searched to identify randomised controlled trials comparing powered and manual toothbrushes. Trials of less than 28 days duration, or where toothbrushing was supervised, were excluded. Assessment of relevance, data extraction and validity assessment were all undertaken independently and in duplicate by two reviewers. Included studies were grouped according to the mode of action of the powered toothbrush. The primary outcomes were plaque and gingival health with data defined as either short-term (1-3 months) or long-term (greater than 3 months) duration were analysed. Powered brushes were categorised into six groups depending on mode of action. Numerical data extracted were checked by a third reviewer for accuracy and entered into RevMan (version 4.1). RESULTS The initial search identified 354 studies. Two hundred and fifteen full articles were obtained of which 29 trials fulfilled the inclusion criteria with results, which could be entered in the meta-analysis. Twenty-six trials (1786 participants) reported short-term and 10 trials (798 participants) long-term plaque scores. Twenty-nine trials (2236 participants) reported short-term and 10 trials (798 participants) long-term gingivitis scores. Powered brushes reduced plaque and gingivitis at least as effectively as manual brushing. Rotation oscillation powered brushes statistically significantly reduced plaque and gingivitis in both the short and long-term. For plaque at one to 3 months the standardised mean difference was -0.44 (95% CI: -0.66 to -0.21), for gingivitis SMD -0.45 (95% CI: -0.76, -0.15). These represented an 11% reduction on the Quigley Hein Plaque index and a 6% reduction on the Löe and Silness gingival index. At over 3 months the effects were SMD for plaque -1.15 (95% CI: -2.02, -0.29) and SMD for gingivitis -0.51 (95% CI: -0.76, -0.25). These represented a 7% reduction on the Quigley Hein Plaque Index and a 17% reduction on the Ainamo Bay Bleeding on Probing Gingival Index. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered brush designs were consistently superior to manual toothbrushes. In these trials, data on cost, reliability and side effects were inconsistently reported. CONCLUSION In general there was no evidence of a statistically significant difference between powered and manual brushes. However, rotation oscillation powered brushes significantly reduce plaque and gingivitis in both the short and long-term. The clinical significance of this reduction is not known. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.
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Affiliation(s)
- C Deery
- Department of Paediatric Dentistry, Edinburgh Dental Institute, Lauriston Place, Edinburgh EH3 9HA, UK.
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Abstract
BACKGROUND Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but sutures may induce tissue reactivity and they usually require removal. Tissue adhesives offer the advantages there are no sutures to remove later for the patient and no risk of needlestick injury to the surgeon. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions. OBJECTIVES To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds. SEARCH STRATEGY The Cochrane Wounds Group Specialised Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Bibliographies of review articles were checked for studies outside the handsearched journals and wound care product manufacturers were contacted. SELECTION CRITERIA Randomised controlled clinical trials only. DATA COLLECTION AND ANALYSIS Screening of eligible studies and data extraction was conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors. MAIN RESULTS Eight RCTs were included (630 patients). No statistically significant differences were found between various tissue adhesives and sutures (8 trials) for dehiscence, infection, satisfaction with cosmetic appearance when assessed by patients' or surgeons' general satisfaction. Nor were differences found between a tissue adhesive and tapes (2 trials) for infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However a statistically significant difference was found for surgeons' assessment of cosmetic appearance with mean difference 13 (95%CI 5 to 21), the higher mean rating for the tissue adhesive group. REVIEWERS' CONCLUSIONS Surgeons may consider the use of tissue adhesives as an alternative to sutures or adhesive tape for the closure of incisions in the operating room. There is a need for trials in all areas but in particular to include patients that require incision closure in areas of high tension and patients of general health that may impair wound healing.
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Affiliation(s)
- P Coulthard
- Oral and Maxillofacial Surgery, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH
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Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä M. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2004:CD001830. [PMID: 15266455 DOI: 10.1002/14651858.cd001830.pub2] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [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: 11/11/2022]
Abstract
BACKGROUND Fissure sealants used on occlusal tooth surfaces were introduced in the 1960s for protecting pits and fissures from dental caries. Although sealants have demonstrated to be effective in preventing caries, their efficacy may be related to the background caries prevalence in the population. OBJECTIVES The primary objective of this review was to evaluate the caries prevention of resin based pit and fissure sealants and glass ionomer cements or sealants in children and adolescents. SEARCH STRATEGY We searched the Cochrane Oral Health Group's Trials Register (last update December 2002), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2002), MEDLINE via OVID (1966 to December 2002), EMBASE (1974 to February 2002), SCISEARCH, SIGLE, CAplus, INSPEC, JICST-EPLUS, NTIS, PASCAL (February 2002) and DARE, NHS EED, HTA (March 2002). Reference lists from included articles and review articles were searched for additional relevant articles. All relevant studies in most languages were considered and translated. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of at least 12 months in duration in which sealants were used for preventing caries in children and adolescents under 20 years of age were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. DATA COLLECTION AND ANALYSIS In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, key words and abstract. In the second phase, four of the reviewers independently classified studies to be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies relative risk ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies comparing resin based sealant with no treatment, fixed effect meta-analyses were used to combine the estimates of relative risk ratios. In one parallel group study, the mean DFS data as continuous data, the effect estimate being the difference in mean DFS, was calculated from data of occlusal surfaces of teeth included in the test and control groups. MAIN RESULTS Eight trials were included in this review of which seven trials were split-mouth studies and one a parallel group study. Six studies provided data for comparing sealant with no treatment and three studies for comparing glass ionomers with resin based sealants. The overall effectiveness of resin based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5 to 10 year old children there were significant differences in favour of the second-generation resin sealant compared with no treatment with pooled relative risk values of 0.14, 0.24, 0.30, 0.43 at 12, 24, 36 and 48 to 54 months respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48 to 54 months. The 24 month parallel group study comparing second-generation resin sealant with control in 12 to 13 year old children found also significantly more caries in the control group children with DFS = 0.65 (95% CI 0.47 to 0.83). Allocation concealment was classified adequate in three of these six studies. However the information on background levels of caries in the population was insufficient to conduct further analyses to estimate the effectiveness of resin based sealants related to baseline caries prevalence. Only one study provided data for the comparison between glass ionomer sealant and control. Based on this, there is not enough information to say whether ionomer sealants are effective, or not. The results of three studies comparing resin sealants with glass ionomer sealants were conflicting and the meta-analyses were not carried out. REVIEWERS' CONCLUSIONS Sealing with resin based sealants is a recommended procedure to prevent caries of the occlusal surfaces of permanent molars. However, we recommend that the caries prevalence level of both individuals and the population should be taken into account. In practice, the benefit of sealing should be considered locally and specified guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.
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Affiliation(s)
- A Ahovuo-Saloranta
- University of Tampere, Lapintie 10 A 7, 33100 Tampere, Tampere, Finland.
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Davies SJ, Gray RJM, Al-Ani MZ, Sloan P, Worthington H. Inter- and intra-operator reliability of the recording of occlusal contacts using 'occlusal sketch' acetate technique. Br Dent J 2002; 193:397-400. [PMID: 12420013 DOI: 10.1038/sj.bdj.4801575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2001] [Accepted: 06/27/2002] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To develop a simple way of recording occlusal contacts with proven inter- and intra-operator reliability. SETTING Clinical skills laboratory in the University Dental Hospital of Manchester. MATERIALS AND METHODS The marked static occlusal contacts of 20 sets of models were recorded in a pseudo-clinical situation, by three dentists and in addition by one dentist on two occasions using a schematic representation of the dental arch - the 'occlusal sketch'. RESULTS The median of Kappa agreement for inter- and intra-operator reliability was almost perfect. CONCLUSIONS The occlusal sketch is a simple, inexpensive and easy way of recording the results of an occlusal examination using marking papers.
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Affiliation(s)
- S J Davies
- Dental Practice, University Dental Hospital of Manchester.
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Worthington H, Clarkson J. Prevention of Oral Mucositis and Oral Candidiasis for Patients with Cancer Treated with Chemotherapy: Cochrane Systematic Review. J Dent Educ 2002. [DOI: 10.1002/j.0022-0337.2002.66.8.tb03559.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Young MP, Carter DH, Worthington H, Korachi M, Drucker DB. Microbial analysis of bone collected during implant surgery: a clinical and laboratory study. Clin Oral Implants Res 2001; 12:95-103. [PMID: 11251657 DOI: 10.1034/j.1600-0501.2001.012002095.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dental implant surgery produces bone debris which can be used to correct bone defects in the "simultaneous-augmentation" technique. However, this debris is potentially contaminated with oral bacteria. Therefore, this study examined bone debris collected during dental implant surgery in order 1) to identify the microbial contaminants and 2) to compare the effects of two different aspiration protocols on the levels of microbial contamination. Twenty-four partially dentate patients were randomly allocated into two equal groups and underwent bone collection using the Frios Bone Collector during surgery to insert two endosseous dental implants. In group S (using a stringent aspiration protocol), bone collection occurred within the surgical site only. In group NS (utilizing a non-stringent aspiration protocol), bone collection and tissue fluid control was achieved using the same suction tip. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilized for identification of the isolated microbes. Twenty-eight species were identified including a number associated with disease, in particular, Enterococcus faecalis and Staphylococcus epidermidis as well as the anaerobes Actinomyces odontolyticus, Eubacterium sp., Prevotella intermedia, Propionibacterium propionicum and Peptostreptococcus asaccharolyticus. In group S (stringent aspiration protocol), significantly fewer organisms were found than in group NS, the non-stringent aspiration protocol (P=0.001). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is collected for implantation around dental implants, it should be collected with a stringent aspiration protocol (within the surgical site only) to minimize bacterial contaminants.
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Affiliation(s)
- M P Young
- Department of Dental Surgery & Medicine, Turner Dental School, University of Manchester, Manchester, United Kingdom.
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Jones CM, Worthington H. Water fluoridation, poverty and tooth decay in 12-year-old children. J Dent 2000; 28:595. [PMID: 11082529 DOI: 10.1016/s0300-5712(00)00051-8] [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: 11/16/2022] Open
Affiliation(s)
- CM Jones
- Highland Health Board, Assynt House, Beechwood Park, IV2 3HG, Inverness, UK
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Tickle M, Kay E, Worthington H, Blinkhorn A. Predicting population dental disease experience at a small area level using Census and health service data. J Public Health Med 2000; 22:368-74. [PMID: 11077912 DOI: 10.1093/pubmed/22.3.368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Information on the dental disease patterns of child populations is required at a small area level. At present, this can be provided only by expensive whole population surveys. The aim of this study was to evaluate the ability of Census data combined with health service information to provide estimates of population dental disease experience at the small area level. METHOD Clinical dental data were collected from a large cross-sectional survey of 5-year-old children. A preliminary series of bivariate linear regression analyses were undertaken at ward level with the mean number of decayed, missing or filled teeth per child (dmft) as the dependent variable, and the Census and health service and lifestyle variables suspected of having a strong relationship with dmft as independent variables. This was followed by fitting a multiple linear regression model using a stepwise procedure to include independent variables that explain most of the variability in the dependent variable dmft. RESULTS All deprivation indicators derived from the Census showed a highly significant (p<0.001) bivariate linear relationship with ward dmft. The Jarman deprivation score gave the highest R2 value (0.45), but the Townsend index (R2=0.43) and the single Census variable 'percentage of households with no car' (R2 = 0.42) gave very similar results. The health and lifestyle indicators also showed highly significant (p<0.001) linear relationships with dmft. The R2 values were generally much lower than the deprivation-related Census variables, with the exception of the percentage of residents who smoked (R2 = 0.42). None of the health or lifestyle variables was included in the final dental disadvantage model. This model explained 51 per cent of the variability of ward dmft. CONCLUSIONS The results demonstrate the strong relationship between dental decay and deprivation, and all of the commonly used measures of deprivation exhibited a similar performance. For this population of young children health and health services shelf data did not improve on the ability of deprivation-related Census variables to predict population dental caries experience at a small area level.
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Abstract
AIM To examine the influence of water fluoridation, and socio-economic deprivation on tooth decay in the permanent dentition of 12 year old children. SETTING The North of England, fluoridated Newcastle and non-fluoridated Liverpool. A total of 6,638 children were examined. OUTCOME MEASURES Multiple Regression analysis of fluoride status, mean electoral ward DMFT in 1992/93 and ward Townsend Scores from the 1991 census. RESULTS Social deprivation and tooth decay were significantly correlated in areas with and without water fluoridation. Multiple linear regression showed a statistically significant interaction between ward Townsend score, mean DMFT and water fluoridation, showing that the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 37% reduction in decay in 12-year-olds in fluoridated wards. CONCLUSIONS Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has markedly reduced tooth decay in 12-year-old children and that socio-economic dental health inequalities are reduced.
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Affiliation(s)
- C M Jones
- Highland Health Board, Assynt House, Beechwood Park, Inverness, UK
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Coulthard P, Bridgman C, Larkin A, Worthington H, Coulthard DP. Appropriateness of a Resuscitation Council (UK) advanced life support course for primary care dentists. Br Dent J 2000. [DOI: 10.1038/sj.bdj.4800523a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Joshi A, Doyle L, Worthington H, Joshi A. Direct access day case oral surgery. Br Dent J 2000. [DOI: 10.1038/sj.bdj.4800507a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jones C, Woods K, Whittle G, Worthington H, Taylor G. Sugar, drinks, deprivation and dental caries in 14-year-old children in the north west of England in 1995. Community Dent Health 1999; 16:68-71. [PMID: 10641059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To examine associations between dental caries and reported drink consumption. DESIGN A cross-sectional caries prevalence study including reported drink consumption. SETTING Secondary schools across the former North Western Region of England. SUBJECTS A random sample of 6,014, 14-year-old children. RESULTS The mean DMFT of the sample was 2.74. The reported mean weekly consumption of cans of carbonated drinks was 5.66, with a range of zero to 42. There was a significant gender difference in drink consumption and a significant correlation between the reported weekly consumption of cans of carbonated drinks and DMFT. Logistic regression analysis showed tea drinkers had a significantly lower DMFT than coffee drinkers and that this effect was independent of the addition of sugar and the number of cans of drink consumed. Reported use of sugar-free carbonated drinks was not associated with better dental health. CONCLUSIONS Reported consumption of sugared drinks and carbonated drinks was associated with significantly higher levels of dental caries. Drinking tea was associated with lower levels of caries. Sugar-free drinks were not associated with better dental health.
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Affiliation(s)
- C Jones
- North West Dental Public Health Resource Centre, Wesham Park Hospital, UK
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Abstract
OBJECTIVES This prospective study was conducted to describe the incidence of tooth extraction in a group of regularly attending adults and to assess factors that are predictive of tooth loss. METHODS Baseline and annual incremental clinical data were obtained from 23 general dental practitioners on a group of their regularly attending, dentate adult patients over a 5-year period. The patients completed a postal questionnaire with questions relating to dental health behaviours, attitudes and knowledge, and social factors. RESULTS Complete clinical data were obtained from 2799 patients. Four hundred and seventy (17%) patients underwent extractions, 72% of which were posterior teeth. The majority of extractions were for reasons other than caries (79%). Bivariate analyses revealed many significant differences between patients who underwent extractions and those who did not, with respect to the clinical, social, behavioural and attitudinal variables. The logistic regression model for tooth loss included three clinical variables, number of teeth, crowns and sites with recession. Other variables in the final model included the dentist's and patient's prediction of treatment need, having sensitive teeth, having a sweet tooth, living alone and smoking. The sensitivity for the model was 0.57 with specificity 0.72. CONCLUSIONS This study is unique in its examination of patients and has highlighted that both clinical and other factors are important in predicting who will undergo extractions. Future investigations should assess the consequence of having extractions in terms of health benefit or detriment.
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Affiliation(s)
- H Worthington
- Dental Health Unit, Turner Dental School, Manchester, UK.
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Ledgerton D, Horner K, Devlin H, Worthington H. Radiomorphometric indices of the mandible in a British female population. Dentomaxillofac Radiol 1999. [DOI: 10.1038/sj.dmfr.4600435] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ledgerton D, Horner K, Devlin H, Worthington H. Radiomorphometric indices of the mandible in a British female population. Dentomaxillofac Radiol 1999; 28:173-81. [PMID: 10740473 DOI: 10.1038/sj/dmfr/4600435] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To examine the radiomorphometric indices of the mandible on panoramic radiographs in a population of British female patients, to identify their normal ranges and to investigate their relationships with age, detentition and social class. METHODS Five indices, cortical width at the gonion (GI) and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) and one new index (measurement of cortical width at the antegonion; AI), were measured bilaterally on 500 panoramic radiographs of females by one trained observer. The measurements were analysed for ease of application, repeatability, relationships with age, dentition and social class and interrelationships between the variables. RESULTS All quantitative indices (GI, MI, PMI, AI), showed a significant, negative correlation with age. MCI showed an age-related distribution. Mandibular dentition exerted a significant influence on some indices, but social class had no influence. Intra-observer repeatability of MI, PMI and AI was fair (precision < 20%) but that for GI was poor. Intra-observer agreement in MCI assessments was excellent. CONCLUSIONS The age-related changes in mandibular radiomorphometric indices and their variation within each age band lend support to their potential use in identification of skeletal osteopenia. However, problems with repeatability and measurement precision identified in the pilot study, notably with GI, may be a considerable obstacle to their use in general practice.
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Affiliation(s)
- D Ledgerton
- University Dental Hospital of Manchester, UK
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Jones C, Worthington H. The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children. Br Dent J 1999. [DOI: 10.1038/sj.bdj.4800122a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
AIM To examine the relationship between water fluoridation, socioeconomic deprivation and tooth decay in 5-year-olds. SETTING 10,004 children: 1,051 in naturally fluoridated Hartlepool in 1991/92, 3,816 in fluoridated Newcastle & North Tyneside and 5,137 in non-fluoridated Salford & Trafford in 1993/94. OUTCOME MEASURES Correlations between mean electoral ward dmft and ward Townsend Scores from the 1991 census. RESULTS Regardless of the level of water fluoridation significant correlations were found between deprivation and tooth decay. Multiple linear regression models for dmft showed a statistically significant interaction between ward Townsend score, and both types of water fluoridation, confirming the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 43% reduction in decay in 5-year-olds in fluoridated areas. CONCLUSIONS Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has halved tooth decay in 5-year-old children and that the dental caries divide between rich and poor is reduced.
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Worthington H. Glaxo's AZT announcement welcomed, but detail is yet to follow. mother-to-child transmission. AIDS Anal Afr 1998; 8:2. [PMID: 12293621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Worthington H, Clarkson J. Evidence-based reviews. Br Dent J 1998; 184:264. [PMID: 9634270 DOI: 10.1038/sj.bdj.4809608] [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: 02/07/2023]
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Worthington H. Where voluntary testing has produced results. AIDS Anal Afr 1997; 7:3. [PMID: 12348322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abstract
This prospective study was conducted to determine factors important in predicting which regularly attending adult patients would receive first, restorations or extractions for any reason (receiving treatment) and, second, restorations or extractions undertaken specifically for caries (receiving treatment related to caries). Baseline and incremental clinical data were obtained from 24 general dental practitioners on a group of their regularly attending, dentate adult patients over a 12-month period. The patients completed a postal questionnaire with questions relating to dental health behaviour, attitudes, knowledge, and social factors. Complete data were obtained from 2553 patients. Thirty-one variables were identified as potential predictors for the two dependent variables receiving treatment and receiving treatment related to caries, and logistic regression models were fitted. Receiving treatment was associated with having fewer sound teeth and more anterior fillings, posterior fillings and crowns (P < 0.001). The dentist's prediction of the need for treatment related to caries and the patient's own prediction of the need for a filling were also important in the model (P < 0.001). Some of these variables, together with having received recent medical treatment and taking sugar in tea or coffee were also found to predict treatment related to caries. The model for receiving treatment related to caries was more successful at predicting the patient's individual risk but the model for receiving treatment was slightly better at classifying patients into whether or not they received treatment. It is reassuring that the common assumptions made by the dental practitioners of their patient's risk have received statistical validation.
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Affiliation(s)
- H Worthington
- Dental Health Unit, Turner Dental School, Manchester, UK
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Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofac Radiol 1997; 26:95-100. [PMID: 9442624 DOI: 10.1038/sj.dmfr.4600215] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the intra-observer repeatability and inter-observer reproducibility of the measurements used in deriving the Panoramic Mandibular Index (PMI). METHODS Two observers measured 21 dental panoramic radiographs independently of each other, both repeating the measurements after a period of 1 week. The measurements were then evaluated using a number of statistical methods. RESULTS All sets of compared measurements, both within and between observers, demonstrated significant positive correlations, with no significant difference between measurements Precision, however, was poor and variable. CONCLUSION The main difficulties in obtaining consistency in repeated measurements were related to individual morphology and radiodensity. In order to improve the validity of the PMI as a measure of local bone loss, repeatability of the measurements should be improved. Suggestions as to how this, might be achieved are discussed.
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Affiliation(s)
- D Ledgerton
- Department of Dental Medicine, Turner Dental School, University Dental Hospital of Manchester, UK
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Abstract
AIM To identify those patients most likely to fail to attend dental appointments. DESIGN Retrospective analysis of the attendance pattern of patients. SETTING A National Health Service practice in Kent. SUBJECTS AND METHODS Dental records of 1000 patients. MAIN OUTCOME MEASURES Data (age, gender, plaque score, treatment planned, whether the patient was exempt from charges, distance between their home and the practice) were related to attendance history. RESULTS 34.8% of patients receiving income support and 24.8% of children failed to attend compared with 18.6% of non-exempt adults. Differences between non-exempt adults and children [per cent difference 6.2%, CI = (0.6%, 11.8%)] and for those receiving income support [per cent difference 16.2%, CI = (6.2%, 26.2%)] were significant (P < 0.05). A significant improvement in the appointment failure rate was achieved using telephone reminders. CONCLUSIONS Patients exempt from dental charges (mainly children and those receiving income support) were more likely to have failed to attend for their appointment. Whereas the attendance of children may be outside their control in some cases, we hypothesise that factors such as poverty in the group receiving income support may be an important influence in whether these patients feel able to attend for their appointments.
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Abstract
This study investigated the use of the periotest for measuring tooth mobility of upper permanent incisor teeth in children. A total of 160 children, with equal numbers of boys and girls aged between 9 and 16 years had two periotest readings made on their four upper incisor teeth. In all 1,280 measurements were collected and analysed. The results showed that the second periotest readings were statistically significantly higher than the first. Periotest readings were lower for girls than boys of the same ages. The periotest may have a place as a diagnostic tool in paediatric dentistry and dental traumatology, however, further research is necessary before the periotest can be used to assist in the diagnosis and assessment of healing of traumatised teeth.
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Affiliation(s)
- I Mackie
- Department of Dental Medicine and Surgery, University Dental Hospital of Manchester, England
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Herrick AL, Worthington H, Rieley F, Clarke D, Schofield D, Braganza JM, Jayson MI. Dietary intake of micronutrient antioxidants in relation to blood levels in patients with systemic sclerosis. J Rheumatol 1996; 23:650-3. [PMID: 8730121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To document habitual intakes of micronutrient antioxidants in patients with systemic sclerosis (SSc) in light of studies reporting subnormal levels of ascorbate and selenium in this patient group. METHODS Dietary intakes of vitamin C, selenium, alpha-tocopherol, beta-carotene, and sulfur amino acid precursors of glutathione were assessed using the 7 day weighed record in 12 patients with SSc and in 12 healthy control subjects. The intakes of the first 4 substances were examined in relation to plasma/serum levels, while intakes of sulfur amino acids were examined in relation to urinary inorganic sulfate. RESULTS Antioxidant and sulfur amino acid intakes were similar in patients and controls, although the patients had lower levels of selenium (median 74 compared to 87 milligrams in controls; p = 0.014) and of vitamin C in plasma (median 6.0 compared to 11.1 milligrams/l in controls; p = 0.08). Inorganic sulfate concentration in urine was similar in patients and controls. CONCLUSION Our results suggest that reduced blood levels of the water soluble antioxidants selenium and ascorbic acid in patients with SSc are not due to dietary deficiency. Other explanations must therefore be sought.
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Affiliation(s)
- A L Herrick
- University of Manchester Rheumatic Diseases Centre, Hope Hospital, Salford, UK
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Abstract
It is proposed that gallstones stem from insufficiency of micronutrient antioxidants relative to the load of oxidants and/or oxidation-prone substrates within hepatocytes in such a way that ancillary hepatobiliary resources, including bilirubin with lactoferrin and mucin, are mobilized to combat oxidative stress but inadvertently promote lithogenesis. Aberrant activities of hepatic cytochrome P450 mono-oxygenases and of haem oxygenase are integral to this template, because differential inhibition or activation of these enzymes would help to rationalize the spectrum of human gallstone composition and also the different outcomes when animals are fed the same lithogenic diets. The hypothesis is based on a decade of work on another lithogenic disease, chronic pancreatitis. It accommodates observations on human and experimental gallstones, it is testable and, as shown by studies of chronic pancreatitis, has implications for primary disease prevention.
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Affiliation(s)
- J M Braganza
- Department of Medicine, Royal Infirmary, Manchester, UK
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50
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Burke FJ, Worthington H, Wilson NH. Oral health index. Br Dent J 1995; 178:168. [PMID: 7702947 DOI: 10.1038/sj.bdj.4808690] [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: 01/26/2023]
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