Dental practice in the UK in 2015/2016. Part 2: aspects of direct restorations, bleaching, endodontics and paediatric dentistry.

Objective To follow up related studies reported in 2004/2005 and 2011/2012 by investigating aspects of direct restorations, bleaching, endodontics and paediatric dentistry in general dental practice, as part of a survey of arrangements and procedures in the clinical practice of dentistry. Methods The data presented were extracted from the data obtained from a piloted, 121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. Percentages reported are based upon the number of respondents who answered each question, given that not all respondents answered all 121 questions included in the questionnaire. Results Between 2008 and 2015, composite displaced amalgam as the material most commonly used by general dental practitioners (GDPs) for the restoration of two surface cavities in premolars and permanent molar teeth. Only 24% of respondents were of the view that dental amalgam should continue to be used freely, but not because of environmental or mercury toxicity concerns. In applying minimum intervention dentistry approaches, repair rather than replacement was considered by most GDPs for the management of defective restorations, irrespective of the material forming the restoration. The provision of home-based, vital bleaching had increased since 2008, with tooth sensitivity being the most commonly reported, unwanted side effect. A small majority of respondents (54%) were of the view that facial soft tissue aesthetics should be considered the practice of dentistry. Rubber dam was widely used in endodontic procedures (85%) but not for other procedures. Rotary instrumentation was routinely used in root canal treatment by 88% of the respondents. A greater percentage of respondents indicated that they would use a preformed metal crown to restore primary molars either routinely or occasionally, compared to eight years ago (35% cf 23%). Over three quarters of the respondents had heard of the Hall crown technique, and 50% of them had used it to good effect in their practices. Conclusion Key aspects of general dental practice in the UK changed between 2008 and 2015, highlighting the dynamic nature of clinical practice and the scope of practice of dentistry. Studies of the type reported are considered important in investigating trends and developments in dentistry

Dental practice in the UK in 2015/2016. Part 4: changes since 2002?

Objectives To determine, by means of anonymous self-report questionnaires, the changes in demographic profile, practising details and utilisation of clinical techniques/materials of general dental practitioners (GDPs) in the UK between 2002 and 2015. Method A wide-ranging, validated questionnaire, designed to elicit information on the practising arrangements and techniques and materials used, was distributed to UK-based GDPs in 2002, 2008 and 2015 with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results Questionnaires were distributed by post to 1,000 UK-based GDPs in 2004 and 2008, with an additional 500 questionnaires being distributed at postgraduate meetings in 2015. Response rates of 70%, 66% and 78% were achieved, respectively. Of the respondents, 73% were male in 2002, while 67% and 60% were male in 2008 and 2015, respectively. In 2002, 65% were practice principals, falling to 51% in 2015. Regarding how patients paid for their dental care, 86% of respondents in 2002 treated patients within the NHS arrangements, compared with 57% and 50% in 2008 and 2015, respectively. The data collected in 2015 indicated that 55% of respondents had an intra-oral camera; while, with regard to recently introduced concepts and techniques, 80% used nickel-titanium files, 47% used zirconia-based bridgework, 25% used tricalcium silicate, and 17% used CAD/CAM restoration. Of great interest, perhaps, is the response to digital radiography/imaging, with the results indicating that, by 2015, 74% of respondents used this form of radiography. Conclusion Results from the three surveys indicated that NHS service provision has dropped to 50%. Regarding the staffing of dental practices, just over half the respondents were practice principals. The results also indicated that UK dentists continue to be innovative and forward-looking in the techniques that they employ

Dental practice in the UK in 2015/2016. Part 3: aspects of indirect restorations and fixed prosthodontics.

Objective This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials. Methods The data presented were extracted from the data obtained from a validated, 121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. Results A response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material. Conclusion Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pins continued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry

Contemporary teaching of bridges (fixed partial dentures) in Ireland and United Kingdom dental schools

Aim The aim of this study was to investigate and describe the current teaching of bridges (fixed partial dentures) within dental schools in Ireland and the United Kingdom. The authors previously surveyed this teaching in 2009. Method Following receipt of positive ethical approval, an online survey was distributed to the 18 dental schools in Ireland and the United Kingdom with primary dental degree programmes in 2017. This questionnaire sought information about the current nature and extent of dental school teaching of bridges, including clinical techniques taught. Information was also sought on current and future challenges to teaching in this area. Results Responses were received from all 18 schools invited to participate (response rate = 100%). There was diversity in the range of exercises completed in preclinical courses for bridgework: the greatest commonality was seen in relation to preparation exercises for fixed-fixed posterior conventional bridges (n = 14 schools) and cantilever anterior resin-retained bridges (n = 13 schools). Fourteen schools required students to complete a preclinical assessment before they were permitted to provide bridgework in a clinical setting. Anterior cantilevered resin retained bridges were the most common clinical treatment provided (average = 1.67 bridges per student per respondent school; range = 0–3), representing a two-fold increase since the 2009 survey, which indicated that the equivalent mean was 0.83 per student. Two schools permitted their students to provide all-ceramic anterior bridges clinically. Five schools reported that their teaching of bridges had reduced over the past 5 years. Within the respondent schools, the most common challenges cited to teaching bridges was a lack of suitable patients (13 schools) and lack of time within the primary dental degree programme (7 schools). Conclusions This study found increased student experience in the clinical provision of bridgework, in particular the provision of anterior cantilever resin-retained bridges, compared to the time of the last survey in 2009. Aspects of the teaching of removable partial dentures and implant dentistry should be surveyed to identify how these areas of teaching are adapting to changing patterns of oral healthcare and the further refinement of developing technologies in these areas

Dental amalgam and mercury in dentistry

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Mercury in dentistry has re-emerged as a contentious issue in public health, predominantly because so many people are inadvertently exposed to mercury in order to obtain the benefits of dental amalgam fillings, and the risks remain difficult to interpret. This commentary aims to examine the issues involved in public policy assessment of the continued use of dental amalgam in dentistry.AJ Spence