Explore the vast range of titles available.

Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score. Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment. Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists’ lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. ‘Fee only’ was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

Key Points Bullying is endemic in schoolchildren. The effects of bullying in schoolchildren can result in both psychological and physical symptoms. Children with an untreated malocclusion appear to be at greater risk of bullying. Management of bullying due to the presence of a malocclusion should involve school anti-bullying policies and referral to medical and dental specialties. Bullying in school-aged children is a global phenomenon. The effects of bullying can be both short- and long-term, resulting in both physiological and psychological symptoms. It is likely that dental care professionals will encounter children who are subjected to bullying. The aim of this narrative review is to discuss the incidence of bullying, the types of bullying, the effects of bullying and the interventions aimed at combating bullying in schoolchildren. The role of dentofacial aesthetics and the relationship of bullying and the presence of a malocclusion are also discussed.

Key Points Discusses the integration of oral and general health. Reports the results of a pilot examining the provision of health screening in dental practices. Discusses the extended role of dental care professionals. Outlines the challenges involved in delivering screening programmes in dental practices. Background Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment. Aim To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool. Method The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members. Results A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening. Conclusion The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.

Key Points Evaluates the use of a new Y-TZP material, for the construction of 3 and 4-unit fixed-fixed posterior and anterior all-ceramic bridges in general practice. Discusses the satisfactory results at year one of a three-year trial. The trial continues to monitor the restorations over a three-year period. Purpose To report the results at year one of a three-year evaluation of the performance of fixed all-ceramic bridges, constructed with a yttrium tetragonal zirconia polycrystal substructure placed in adult patients in UK general dental practices and cemented using a self-adhesive resin-based cement. Methods Ethical approval was obtained. Four UK general dental practitioners were asked to recruit patients complying with the trial criteria and protocol. After obtaining informed written consent, appropriate vitality and radiographic assessments were completed and the pre-operative status of the gingival tissues noted. The teeth were prepared and bridges constructed using the same technician and laboratory procedures. Each bridge was reviewed within three months of the anniversary of its placement by a calibrated examiner together with the clinician who had placed the restoration. The examiners evaluated the integrity of the restoration, its anatomic form, marginal adaptation, surface quality, sensitivity, the condition of the adjacent gingivae, and the presence or absence of secondary caries. Results All the bridges (n = 38) examined at the first-year review were present, intact and performing well, though one small chip of the veneering porcelain was detected and in two cases an abutment tooth had been endodontically treated through an occlusal access cavity.

AIM: To assess the current awareness, usage and opinion of the Hall technique as a restorative option for primary molars in Scottish general dental practice; and to identify preferences for methods of further training, if desired, for those not currently using the technique. STUDY DESIGN : A postal questionnaire was sent to a random sample of Scottish general dental practitioners (GDPs) (n= 1207). Half of all GDPs within each health board were contacted. All analyses were carried out in Minitab (version 15). The study was primarily descriptive and used frequency distributions and cross-tabulations. Percentages are reported with p5% confidence intervals. Characteristics of the whole sample were reported. However when recording the use of the Hall technique, only those GDP’s reporting to treat children, at least sometimes, are considered. RESULTS : Following two mail-shots, the overall response rate was 59% (715/1207). Eighty-six percent (616/715) of respondents were aware of the Hall technique as a method of restoring primary molars and 48 % (n=318) were currently using the Hall technique. Of those GDPs who never used the Hall technique (51% of total respondents; n=340), 46% (n=157) indicated they were either ‘very interested’ or ‘interested’ in adopting the Hall technique into their clinical practice. The preferred source for further training was via a section 63 continuing professional development (CPD) course, incorporating a practical element. CONCLUSIONS : Of those GDPs in Scotland who responded to the questionnaire, an unexpectedly high number were already using the Hall technique in their practice, and among those not currently using it, there is a demand for training.

Key Points Most dental patients appear to prefer to collaborate with, or even defer to their dentist, rather than take an active role in planning their own treatment. Patients who have lost confidence in their dentist seem to have an increased desire for participation in treatment decisions. The extent to which patients want to be involved in decisions about their dental treatment depends on many factors, and may vary within an individual, depending on circumstances. Identifying and accommodating patients' role preferences had great relevance in dentistry. Aims To assess the transferability of the Control Preferences Scale to dental settings and to explore patients' preferred and perceived roles in dental treatment decision-making. Setting and participants A convenience sample of 40 patients, 20 recruited from the University Dental Hospital of Manchester and 20 from a general dental practice in Cheshire. Methods A cross-sectional survey, using the Control Preferences Scale, a set of sort cards outlining five decisional roles (active, semi-active, collaborative, semi-passive, passive), slightly modified for use in dental settings. A second set of cards was used to identify perceived decisional role. Rationale for choice of preferred role was recorded verbatim. Results The Control Preferences Scale was found to be transferable to dental settings. All patients in the sample had identifiable preferences regarding their role in treatment decision-making. A collaborative decisional role, with patient and dentist equally sharing responsibility for decision-making, was most popular at both sites. However, patients at both sites typically perceived themselves as attaining a passive role in treatment decisions. Lack of knowledge about dentistry and trust in the dentist were reported contributors to a passive decisional role preference, whilst those with more active role preferences gave rationales consistent with a consumerist stance. Conclusions This exploratory study's findings suggest that dental patients have distinct preferences in relation to treatment decision-making role and that these may not always be met during consultations with their dentist. The Control Preferences Scale appears to be appropriate for use in dental settings.

Key Points This study suggests that a relatively small proportion of care delivered can be defined as 'complex restorative treatment'. There is considerable potential for delegation of care to dental hygienists and therapists. The findings assume that all the care currently provided is clinically necessary and appropriate. Further work is required on the economic aspects of employing dental hygienists and therapists in general dental practice. This study describes the proportion and volume of work undertaken in primary dental care that could be delegated to hygienists and therapists. Methods Data on treatment provision, both NHS and private, over one course of treatment for 850 consecutively attending patients at 17 dental practices, selected to be representative of a range of socioeconomic, urban and rural environments, were extracted from case records. Results The 850 patients attended on 2,433 occasions. Diagnostic examination accounted for 833 (34.2%) visits, while simple, intermediate and complex restorative interventions and other complex interventions accounted for 500 (20.5%), 361 (14.8%), 365 (15%) and 374 (15.4%) visits respectively. The total time required to provide the care was 42,800 minutes, of which 6,550 (15.3%) were devoted to diagnostic examinations, while 10,485 (24.5%), 7,935 (18.5%) and 11,790 (27.5%) were taken up with simple, intermediate and complex restorative care. Other complex interventions accounted for 6,040 (14.2%) minutes. Assuming that dental therapists are permitted to undertake simple and intermediate restorative interventions, they could provide 35.3% of care when number of visits is utilised as the outcome measure, but 43% of the clinical time taken to provide care. Delegation of diagnostic and treatment planning powers to dental therapists could potentially result in 69.5% of visits and 58.3% of clinical time being provided by therapists. Conclusion These data imply that a considerable proportion of work in UK general dental practice could be delegated to dental hygienists and therapists.

Key Points Discusses the integration of oral and general health. Reports the results of a pilot examining the provision of health screening in dental practices. Discusses the extended role of dental care professionals. Outlines the challenges involved in delivering screening programmes in dental practices. Background Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment. Aim To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool. Method The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members. Results A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening. Conclusion The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.