An audit of the caries status of patients about to start orthodontic treatment

STATEMENT OF THE PROBLEM: All dental caries needs must be addressed before orthodontic treatment in those deemed eligible for orthodontic treatment under HSE (Health Services Executive) guidelines.1 PURPOSE OF THE STUDY: To evaluate the prevalence of carious lesions in permanent teeth requiring restoration in patients from the North Cork area of HSE South taken off the Cork University Dental School and Hospital postqraduate orthodontic treatment waiting list. MATERIALS AND METHODS: A data collection form was designed and applied to 100 consecutive patients taken off the postgraduate orthodontic treatment waiting list from October 2009, A gold standard based on a similar audit carried out in the UK2 was adopted. Results: Carious lesions in permanent teeth requiring restorative intervention were found in 42% of patients (48.9% of males and 35.3% of females). Sixty carious lesions requiring restorations were detected on posterior bitewings and 34 on DPTs, in patients where both forms of radiograph were used. Caries were detected in one-third of the 6% of patients who had attended a primary care dentist in the previous six months. Conclusions: A total of 42% of this patient cohort failed the adopted gold standard by exhibiting caries requiring restoration in permanent teeth, with males showing a higher prevalence. A total of 43% of carious lesions detected by posterior bitewing radiographs were not detected on DPTs of the same patients. Six patients had attended a primary care dentist in the six months before being taken off the orthodontic treatment waiting list and two patients were diagnosed with carious lesions that required restoration.     

Study of the initial enamel injuries in vitro

The purpose of the study was production under laboratory conditions of enamel changes corresponding to early caries. The study was carried out on 20 healthy human teeth in vitro, in two phases differing in the conditions of the experiment. Carietic changes were produced with lactate buffer (in concentrations from 0.025 to 1.0 M) as fluid without added inhibitor of the solubility of the superficial layer. The assessment of the degree of enamel demineralization was based on images obtained in JSM 50A scanning microscope. In the first stage of the experiment a minimal demineralization of the subsuperficial layer of the enamel was obtained. In the second stage besides damage to the subsuperficial layer enamel erosion was noted. In this connection further studies are necessary for determining of the proper conditions for obtaining initial enamel damage.     

Effect of a consensus statement on initial treatment for traumatic dental injuries

Abstract – The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1–17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.     

An audit of root canal treatment performed by undergraduate students

AIM: The objective of this study was to audit the quality of root canal treatment performed by undergraduate students on adult patients. METHODOLOGY: All root canal treatment completed by first and second clinical year undergraduates over a 12-month period were included in the study. The availability and readability of pretreatment, diagnostic length, try-in point and postoperative radiographs were noted for each case. All readable postoperative radiographs of primary treatments were examined for quality of the root filling, categorized as complete, incomplete apical, incomplete apical and lateral or not assessable. The distance from the radiographic apex of the root to the apical extent of each root filling was measured to 0.1 mm precision. RESULTS: Undergraduates performed primary treatment on 157 teeth. A postoperative radiograph was available in 97% of cases. A try-in point radiograph was unavailable in one-fifth of cases. Twenty-seven teeth (13%) were categorized as satisfactory in terms of both radiographic quality and distance of the root filling from the radiographic apex. CONCLUSIONS: Overall, the technical quality of root canal treatment completed by undergraduate students was poor.     

Probing depth at re-evaluation following initial periodontal therapy to indicate the initial response to treatment

9 adult subjects with severe periodontitis were monitored following oral hygiene instruction and a single episode of crown and root debridement. Baseline recordings for probing attachment level were obtained both immediately pre-instrumentation and immediately post-instrumentation. Sites with gain, no change or loss of probing attachment level at 3 and 12 months compared to both pre- and post-instrumentation were identified. The classification was based upon the use of triplicate recordings at each time point, a site-specific standard deviation for measurement variability, and the requirement of a minimum of 1.0 mm change. The relative frequencies of gain, no change, and loss of probing attachment were then calculated for sites of various residual probing depths at 3 and 12 months. This was performed to evaluate if a given probing depth at re-evaluation, e.g., 7.0-7.5 mm, could be used as an indicator of the need for supplementary treatment following the initial therapy, based upon the observed probing attachment changes compared to baseline. As an example of the results of the present study, 60% of sites with residual probing depths of 7.0-7.5 mm showed probing attachment gain greater than or equal to 1.0 mm compared to the post-instrumentation baseline, and only 2% had undergone probing attachment loss greater than or equal to 1.0 mm. The overall results suggest that a relatively deep residual probing depth at re-evaluation following initial therapy, by itself, provides little evidence of lack of improvement compared to baseline. On this basis, the use of a specific probing depth at 3 or 12 months following treatment as a yardstick for the provision of supplementary treatment may not be justified.     

Orthodontic and prosthodontic treatment in dental avulsion cases

A clinical case of traumatic dental avulsion with endodontics, replantation and bracket fixation is presented. Subsequent follow-up led to extraction of the replanted teeth. The edentulous space was restored with a Maryland bridge. The factors which contribute to a successful tooth replantation as well as choosing the right time to begin orthodontic treatment in the case of tooth avulsion and replantation are described.     

An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance

OBJECTIVES: The aim of this audit was to measure the outcome of treatment of acute dentoalveolar infection and to determine if this was influenced by choice of antibiotic therapy or the presence of penicillin-resistance. SUBJECTS AND METHODS: A total of 112 patients with dentoalveolar infection were included in the audit. All patients underwent drainage, either incisional (n=105) or opening of the pulp chamber (n=7) supplemented with antibiotic therapy. A pus specimen was obtained from each patient for culture and susceptibility. Clinical signs and symptoms were recorded at the time of first presentation and re-evaluated after 48 or 72 h. RESULTS: A total of 104 (99%) of the patients who underwent incisional drainage exhibited improvement after 72 h. Signs and symptoms also improved in five of the seven patients who underwent drainage by opening of the root canal although the degree of improvement was less than that achieved by incisional drainage. Penicillin-resistant bacteria were found in 42 (38%) of the 112 patients in this study. Of the 65 patients who were given penicillin, 28 had penicillin-resistant bacteria. There was no statistical difference in the clinical outcome with regard to the antibiotic prescribed and the presence of penicillin-resistant bacteria. Strains of penicillin-resistant bacteria were isolated more frequently in patients who had previously received penicillin (p<0.05). CONCLUSION: Incisional drainage appeared to produce a more rapid improvement compared to drainage by opening of the root canal. The presence of penicillin-resistant bacteria did not adversely affect the outcome of treatment. The observations made support surgical drainage as the first principle of management and question the value of prescribing penicillin as part of treatment.     

An audit of the Yorkshire Regional Cleft Database

This study assessed the validity of the Yorkshire regional orofacial cleft database by comparing the computer-based records with locally collated records of primary surgical events for babies born over a 2-year period (1994-1995). One-hundred-and-thirty-two infants with clefts (excluding submucous cleft palate) were identified from the latter source with an equal proportion of unilateral cleft lip/palate and isolated cleft palate births. However, only 62 per cent of cases were recorded on the database and the reporting rate of individual cleft units was highly variable (43-85 per cent). In addition, there was a significant under-reporting of both cleft lip and isolated cleft palate cases (42 and 50 per cent ascertainment, respectively). Consequently, the database figures understated the prevalence of all cleft births, but especially of these two cleft subtypes. Conversely, the relative frequency of combined cleft lip and palate cases was exaggerated. The reasons for such discrepancies and possible improvements to data collection are discussed.     

New emphasis in the treatment of dental trauma: avulsion and luxation

There are several protocols for the successful management of dental trauma emergencies. However, these existing protocols are inconsistent regarding several issues. As the Israeli dental community and patients have specific characteristics, a modified and adaptable protocol was required. This new protocol contains simple and straightforward clinical guidelines, arranged in table format, according to the nature of the trauma. The present study shows the protocol for luxation and avulsion injuries, with new recommendations for the treatment of luxated closed-apex teeth, the preferred at-site treatment and storage medium for avulsed teeth, and the conditioning of the root surface in these cases. To emphasize and explain the modification of this new protocol, research-based information has been incorporated.