Direct access:how is it working?

AimThe aim of this study was to identify and survey dental hygienists and therapists working in direct access practices in the UK, obtain their views on its benefits and disadvantages, establish which treatments they provided, and what barriers they had encountered.MethodThe study used a purposive sample of GDC-registered hygienists and therapists working in practices offering direct access, identified through a ‘Google’ search. An online survey was set up through the University of Edinburgh, and no-responses followed up by post.ResultsThe initial search identified 243 individuals working in direct access practices. Where a practice listed more than one hygienist/therapist, one was randomly selected. This gave a total of 179 potential respondents. Eighty six responses were received, representing a response rate of 48%. A large majority of respondents (58, 73%) were favourable in their view of the GDC decision to allow direct access, and most thought advantages outnumbered disadvantages for patients, hygienists, therapists and dentists. There were no statistically significant differences in views between hygienists and therapists. Although direct access patients formed a small minority of their caseload for most respondents, it is estimated that on average respondents saw approximately 13 per month. Treatment was mainly restricted to periodontal work, irrespective of whether the respondent was singly or dually qualified. One third of respondents reported encountering barriers to successful practice, including issues relating to teamwork and dentists’ unfavourable attitudes. However, almost two thirds(64%) felt that direct access had enhanced their job satisfaction, and 45% felt their clinical skills had increased.DiscussionComments were mainly positive, but sometimes raised worrying issues, for example in respect to training, lack of dental nurse support and the limited availability of periodontal treatment under NHS regulations

Root canal instrumentation efficacy of non-fused and fused primary molar roots:a micro-computed tomography study

Purpose Pulpectomy may be indicated in restorable primary teeth exhibiting irreversible pulpitis or pulpal necrosis. The purpose of this study was to compare the cleaning and shaping efficacy of NiTi systems (Reciproc(R) Blue and MTwo(R)) with manual stainless-steel instrumentation in primary molars using micro-CT analysis. Methods Fifty-seven maxillary second primary molars were scanned using micro-CT. Teeth with three divergent roots were divided randomly (n = 15) according to instrument type (K file, MTwo (R), and Reciproc (R) Blue). Teeth with root fusion were instrumented manually as a separate group (n = 12). Pre- and post-instrumentation micro-CT images were superimposed, and the instrumentation area (IA) and procedural complications were recorded. Results No statistically significant differences in IA between file systems was observed in the non-fused teeth. The mean IA of fused roots was significantly lower than in the non-fused distobuccal (p = 0.003) and palatal (p 60%) occurred in both non-fused and fused primary teeth with fewer procedural complications observed after manual instrumentation

Biocompatibility and hard tissue-forming ability of CPP-ACP- and CPP- ACFP-modified calcium silicate-based cements

Aims: To evaluate the biocompatibility and osteogenic potential of calcium silicate-based cements (CSCs) modified with casein phosphopeptide – amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide – amorphous calcium fluoride phosphate (CPP-ACFP). Materials and method: Commercially available CSCs were modified with CPP-ACP or CPP-ACFP to prepare CPP-ACP and CPP-ACFP-modified Biodentine™ (0%, 0.5%, 4.0% w/w), Angelus® MTA (0%, 0.5%, 2.0% w/w) and NEX® MTA (0%, 0.5%, 3.0% w/w). For each group, 50 mg, 300 mg and 1500 mg of the cement mixed according to manufacturers’ instructions were placed and adapted at the bottom of 96 well, 24 well and 6 well (respectively) cell culture plates. After 24 h, the cement-coated plates were sterilised by ultraviolet light for 1 h. MG-63, MC3T3-E1, HGF-1, NIH3T3 cells were grown in the cement-coated plates and the cellular proliferation, cellular toxicity, alkaline phosphatase activity, cytokine production (interleukin-1α; IL-1α and interleukin-6; IL-6) and expression of mineralisation-associated proteins (collagen type 1, osteocalcin and osteopontin) were determined. Results: The addition of 0.5% CPP-ACP and 4.0% CPP-ACFP to Biodentine™, and 2.0% CPP-ACFP to Angelus® MTA significantly reduced the proliferation of MG-63. The addition of 4.0% CPP-ACP and 4.0% CPP-ACFP to Biodentine™, 2.0% CPP-ACFP to Angelus® MTA and 3.0% CPP-ACFP to NEX® MTA significantly reduced the proliferation of MC3T3-E1 cells. The tested cements, with and without CPP-ACP and CPP-ACFP, did not induce cellular toxicity nor IL-1α release. The addition of CPP-ACP and CPP-ACFP to Biodentine™ and NEX® MTA, and the addition of CPP-ACP to Angelus® MTA significantly increased the alkaline phosphatase activity of MG-63 cells. The presence of 4.0% CPP-ACP in Biodentine™, 0.5% and 2.0% CPP-ACP in Angelus® MTA, 0.5% CPP-ACFP in Angelus® MTA, and 0.5% CPP-ACFP in NEX® MTA significantly increased the alkaline phosphatase activity of MC3T3-E1 cells. All the tested cements significantly increased the release of IL-6 from MG-63 compared with negative control. The presence of CPP-ACP and CPP-ACFP in NEX® MTA significantly increased the release of IL-6 from MG-63 compared with unmodified NEX® MTA. MC3T3-E1 cells grown on Biodentine™ (unmodified and modified groups) and 3.0% CPP-ACFP-modified NEX® MTA released significantly higher IL-6 compared with negative control. 0.5% CPP-ACFP-modified Biodentine™ and 3.0% CPP-ACFP-modified NEX® MTA induced significantly higher IL-6 release from MC3T3-E1 compared with unmodified Biodentine™ and unmodified NEX® MTA respectively. The tested cements (especially Biodentine™, Angelus® MTA and CPP-ACFP-modified cements) induced the secretion of mineralisation-associated proteins (especially collagen type 1 and osteocalcin).Conclusions: The tested cements are biocompatible, and they could serve as a suitable scaffold which supports cellular proliferation. The addition of CPP-ACP and CPP-ACFP to CSCs improved the cements’ potential to induce osteoblastic differentiation

Evaluation of the Total Design Method in a survey of Japanese dentists

BACKGROUND: This study assessed the application of the Total Design Method (TDM) in a mail survey of Japanese dentists. The TDM was chosen because survey response rates in Japan are unacceptably low and the TDM had previously been used in a general population survey. METHODS: Four hundred and seventy eight dentist members of the Okayama Medical and Dental Practitioner's Association were surveyed. The nine-page, 27-item questionnaire covered dentist job satisfaction, physical practice, and dentist and patient characteristics. Respondents to the first mailing or the one-week follow-up postcard were defined as early responders; others who responded were late responders. Responder bias was assessed by examining age, gender and training. RESULTS: The overall response rate was 46.7% (223/478). The response rates by follow-up mailing were, 18% after the first mailing, 35.4% after the follow-up postcard, 42.3% after the second mailing, and 46.7% after the third mailing. Respondents did not differ from non-respondents in age or gender, nor were there differences between early and late responders. CONCLUSION: The application of TDM in this survey of Japanese dentists produced lower rates of response than expected from previous Japanese and US studies

Cyclic Fatigue of Different Nickel-Titanium Rotary Instruments: A Comparative Study

Since the introduction of nickel-titanium alloy to endodontics, there have been many changes in instrument design, but no significant improvements in the raw material properties, or enhancements in the manufacturing process. Recently, a new method to produce nickel-titanium rotary (NTR) instruments has been developed, in an attempt to obtain instruments that are more flexible and resistant to fatigue. NTR instruments produced using the process of twisting (TF, SybronEndo, Orange, CA) were compared to NTR instruments from different manufacturers produced by a traditional grinding process. The aim of the study was to investigate whether cyclic fatigue resistance is increased for TF NTR files. Tests were performed with a cyclic fatigue device that evaluated cycles to failure of rotary instruments inside curved artificial canals. Results indicated that size 06-25 TF instruments showed a significant increase (P< .05). In the mean number of cycles to failurewhen compared to the other tested 06-25 NTR. Hence, it can be concluded that size 06-25 TF NTR instruments were found to be significantly more resistant to fatigue than those produced with the traditional grinding process

Effect of different exercise programs on the psychological and cognitive functions of people with Parkinson's disease

The purpose of this study was to analyze the effect of different exercise programs on the psychological and cognitive functions in patients with Parkinson's disease (PD). Forty-five patients with PD participated in the study. The participants were randomized in three intervention programs: Group-1 (n=15, cognitive-activities), Group-2 (n=15, multimodal exercise) and Group-3 (n=15, exercises for posture and gait). The clinical, psychological and cognitive functions were assessed before and after 4 months of intervention. Univariate analysis did not reveal significant interactions between groups and time (p>0.05). However, univariate analysis for time revealed differences in stress level and memory. Participants showed less physical stress (p<0.01) and overall stress (p < 0.04) and higher performance in episodic declarative memory (p < 0.001) after exercise. These findings suggest that group work with motor or non-motor activities can improve cognitive and psychological functions of patients with PD

The orthodontic-endodontic interface: trauma and pulpal considerations

The interpretation of the clinical signs and symptoms arising from the interdisciplinary relationship between orthodontics and endodontics becomes more complicated when superimposed by dental trauma. A history of dental trauma before or during orthodontic tooth movement may have implications for pulpal health and clinical outcomes. An understanding of the biology is essential for appropriate treatment planning. This review and treatment recommendations will assist dental practitioners in managing orthodontic-endodontic interactions