Examining the impact of premature birth on parental mental health and family functioning in the years following hospital discharge: A review.

BACKGROUND: This review provides an update of the current research related to the impact of extreme and very premature birth on parental mental health and family functioning following discharge from hospital. METHODS: Full-text peer reviewed articles in English, describing parents' and families' health and wellbeing after the discharge from hospital of their baby using validated questionnaires, were evaluated. Results of included studies are presented in a summarized format. Embase, Medline and PsycINFO databases were accessed in January 2021. RESULTS: 38 studies were included. Nine manuscripts reported on parental mental health and 13 on stress, which are a concern after the birth of a premature infant, especially in the first year. Depression, anxiety, and stress are known to measure higher compared to parents of infants born at term. Over several years, these measures of mental health decrease significantly. Four reported on quality of life for parents of premature infants, which is reduced immediately after discharge, but then improves over time. The impact of premature birth on the family functioning was described in ten included studies and was described to have positive and negative consequences. CONCLUSION: The negative impact of the premature birth and hospital journey on parental mental health lessens significantly with time.

Protecting the brain of the micropreemie.

Advances in perinatal care have seen substantial improvements in survival without disability for extremely preterm infants. Protecting the developing brain and reducing neurodevelopmental sequelae of extremely preterm birth are strategic priorities for both research and clinical care. A number of evidence-based interventions exist for neuroprotection in micropreemies, inclusive of prevention of preterm birth and multiple births with implantation of only one embryo during in vitro fertilisation, as well as antenatal care to optimize fetal wellbeing, strategies for supporting neonatal transition, and neuroprotective developmental care. Avoidance of complications that trigger ischemia and inflammation is vital for minimizing brain dysmaturation and injury, particularly of the white matter. Neurodevelopmental surveillance, early diagnosis of cerebral palsy and early intervention are essential for optimizing long-term outcomes and quality of life. Research priorities include further evaluation of putative neuroprotective agents, and investigation of common neonatal interventions in trials adequately powered to assess neurodevelopmental outcome.

A survey of undergraduate orthodontic teaching and factors affecting pursuit of postgraduate training.

Background Undergraduate orthodontic teaching has been focused on developing an understanding of occlusal development in an effort to equip practitioners to make appropriate referrals for specialist-delivered care. However, there is a growing interest among general dentists in delivering more specialised treatments, including short-term orthodontic alignment. This study aimed to assess the levels of knowledge of occlusal problems among final year undergraduate dental students, as well as their interest in various orthodontics techniques and training.Methods A 36-item electronic questionnaire was sent to all final year undergraduate students in four dental institutes in the UK (Barts and the London, Kings College London, Cardiff and Dundee). The questionnaire explored satisfaction with undergraduate orthodontic teaching; students' perception of knowledge, based on General Dental Council learning outcomes; perceptions of the need for specialist involvement in the management of dental problems; interest in further training in orthodontics; and potential barriers to undertaking specialist training.Results The overall response rate was 66% (239/362). The majority of students (84.1%) were aware of GDC guidance in terms of undergraduate teaching. Students reported a preference for case-based and practical teaching sessions in orthodontics, with less interest in lectures or problem-based learning approaches. A high percentage were interested in further teaching in interceptive orthodontics (60.3%) and fixed appliance therapy (55.7%). Further training including specialist orthodontic training (36.4%), Invisalign (59%) and Six Month Smiles (41%) courses appealed to undergraduates. Levels of student debt, course fees and geographical issues were seen as potential barriers to formal, specialist training pathways.Conclusions Satisfaction with undergraduate orthodontic teaching is high and interest in further training, including specialist training pathways, continues to be high. While short-term orthodontics is not taught at undergraduate level, there appears to be an appetite to undertake alternatives to conventional orthodontics among dental students.

Dental students' experiences of treating orthodontic emergencies - a qualitative assessment of student reflections.

INTRODUCTION: Professional regulatory bodies in the UK and Europe state that dental graduates should be able to manage orthodontic emergency patients. Therefore, the aim of this study was to explore dental student experiences of treating orthodontic emergencies within a teaching institution. MATERIALS AND METHOD: This study was designed as a single-centre evaluation of teaching based in a UK university orthodontic department. The participants were fourth-year dental students who treated orthodontic emergency patients under clinical supervision as part of the undergraduate curriculum. Student logbook entries for one academic year detailing the types of emergencies treated and structured, reflective commentaries for each procedure were analysed using thematic analysis methods. The total numbers and types of orthodontic emergencies treated by students were presented. Overall, self-reported student confidence in managing orthodontic emergencies was calculated. Themes, which represented student reflections, were identified. RESULTS: Seventy-two students participated in the study. Overall, 69% of students stated they were confident in managing orthodontic emergencies. Students treated a range of emergencies, of which the most frequent was debonded brackets (38%). Reflections from student commentaries were housed under a primary theme of building procedural confidence. Three subthemes were identified: (i) theory-practice integration; (ii) expanding clinical experience; and (iii) importance of a supportive clinical learning environment. CONCLUSION: The majority of dental students were confident in managing orthodontic emergencies. Theoretical knowledge supplemented by exposure to a range of clinical problems within a supported learning environment made students feel more confident.

Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

Multilevel principal component analysis (mPCA) in shape analysis: A feasibility study in medical and dental imaging.

BACKGROUND AND OBJECTIVE: Methods used in image processing should reflect any multilevel structures inherent in the image dataset or they run the risk of functioning inadequately. We wish to test the feasibility of multilevel principal components analysis (PCA) to build active shape models (ASMs) for cases relevant to medical and dental imaging. METHODS: Multilevel PCA was used to carry out model fitting to sets of landmark points and it was compared to the results of "standard" (single-level) PCA. Proof of principle was tested by applying mPCA to model basic peri-oral expressions (happy, neutral, sad) approximated to the junction between the mouth/lips. Monte Carlo simulations were used to create this data which allowed exploration of practical implementation issues such as the number of landmark points, number of images, and number of groups (i.e., "expressions" for this example). To further test the robustness of the method, mPCA was subsequently applied to a dental imaging dataset utilising landmark points (placed by different clinicians) along the boundary of mandibular cortical bone in panoramic radiographs of the face. RESULTS: Changes of expression that varied between groups were modelled correctly at one level of the model and changes in lip width that varied within groups at another for the Monte Carlo dataset. Extreme cases in the test dataset were modelled adequately by mPCA but not by standard PCA. Similarly, variations in the shape of the cortical bone were modelled by one level of mPCA and variations between the experts at another for the panoramic radiographs dataset. Results for mPCA were found to be comparable to those of standard PCA for point-to-point errors via miss-one-out testing for this dataset. These errors reduce with increasing number of eigenvectors/values retained, as expected. CONCLUSIONS: We have shown that mPCA can be used in shape models for dental and medical image processing. mPCA was found to provide more control and flexibility when compared to standard "single-level" PCA. Specifically, mPCA is preferable to "standard" PCA when multiple levels occur naturally in the dataset.

Preparing for practice - calibration of dental undergraduate students in the Index of Orthodontic Treatment Need.

OBJECTIVES: The aim of this study was to establish the success in calibrating dental students in the use of the Index of Orthodontic Treatment Need (IOTN). DESIGN: Single-centre, evaluation of teaching study. SETTING: University department, UK, 2013. SUBJECTS AND METHOD: Third-year dental students were divided into four groups and received IOTN instruction via clinical and non-clinical teaching over a three-month period. This was followed by a calibration exercise where the whole year assessed 30 study models for orthodontic treatment need using the dental health component (DHC) and modified aesthetic component (AC) of the IOTN. MAIN OUTCOME MEASURES: Student IOTN scores were compared to a gold standard using kappa statistics (κ). RESULTS: Results showed that although substantial agreement was achieved in both the DHC (κ = 0.65) and a modified AC (unweighted κ = 0.63), the year only calibrated successfully in the DHC. CONCLUSION: Third year dental students taught at Cardiff University applied the DHC of IOTN better than the AC.

Determining normal and abnormal lip shapes at border positions for use as a longitudinal surgical outcome measure.

Objective measures of facial movement are important for interventions where surgical repositioning of facial structures can influence soft tissue mobility and include the management of patients with cleft lip, facial nerve palsy and orthognathic surgery. As such, the aim of this study is to present a method for determining the outcome of surgical procedures on lip shape during speech. A control group (CG) of 115 average subjects and 30 patients with a Class 3 malocclusion requiring bimaxillary surgery performed four reproducible verbal utterances during image capture using a non-invasive, three-dimensional (3D) motion scanner (3dMDFace™ Dynamic System). Landmark coordinates around the lips of the 3D facial shells were extracted and subjected to discriminant analysis and principal component analysis to statistically differentiate lip shapes between the CG and the patient group (PG) pre- and post-surgery. Pre-surgically, the PG showed statistically significant differences in lip shape during speech in the lateral and vertical dimensions, preferring a wider, shorter lip shape when compared with the CG for all the utterances. The shape differences normalised towards the CG post-surgery. The method presented utilises pre-existing statistical shape analyses and can be reproduced in the clinical setting to provide a diagnostic and functional outcome tool. In this example, correction of the Class 3 skeletal disproportions appeared to normalise lip shape during speech.

Management of chronic neuropathic pain following mandibular advancement surgery.

This report highlights the management of a rare complication, namely allodynia, which arose following mandibular advancement surgery. A 56-year-old female underwent bilateral sagittal ramus advancement osteotomy. Postoperatively, she developed allodynia corresponding to the distribution of the left inferior alveolar nerve. A hierarchical pathway of topical and pharmacological agents followed by ablative techniques was used without success. Eventually, electrical neuromodulation via a motor cortex stimulator was implemented to manage the symptoms. The report serves to outline treatment options available and the risks associated with this treatment.

Statistical modelling of lip movement in the clinical context.

OBJECTIVE: To establish three-dimensional (3D) reference data on average lip movement in normal healthy subjects using statistical shape analysis techniques. SETTING AND SAMPLE POPULATION: School of Dentistry and Cardiff School of Computer Science, Cardiff University, United Kingdom. One hundred and fifteen white subjects. MATERIAL AND METHODS: Subjects performed four reproducible verbal gestures (puppy, rope, baby and bob) in a normal relaxed manner, which were captured using a non-invasive, 3D motion scanner (3dMDFace™ Dynamic System). Six landmarks were manually placed around the lips of the 3D facial shells showing maximum lip displacement. Generalized procrustes analysis followed by principal component analysis was applied to the landmark coordinates to characterize lip movement for each word. RESULTS: The first four principal components (PCs) describe the majority of variation in lip movement for the four words involving a complex interaction of lip movements in three dimensions. Bilateral landmarks were paired within PCs showing that movement was largely symmetrical. Female resting lip shape was narrower and shorter in height than males. During motion, females preferred a more protrusive articulation than males. CONCLUSION: Statistical shape analysis techniques can be used to characterize lip movement during articulation. Data from this study can act as a reference for average lip movement to compare similar population groups.

Patent ductus arteriosus in infants <29 weeks gestation--outcomes and factors affecting closure.

OBJECTIVE: To determine Patent ductus arteriosus (PDA) closure rates for extremely preterm infants in a tertiary care centre, factors affecting response to indomethacin and outcomes of these infants relative to their PDA status. SETTING: Neonatal intensive care unit in tertiary-care children's hospital. DESIGN: Retrospective medical record review. METHODS: A retrospective chart review of all infants <29 weeks gestation between 1st Jan 2003 and 30th June 2006 was carried out. Multiple courses of standard intravenous indomethacin (dose: 0.2 mg/kg 12 hourly; 3 doses) followed by a tail course (0.1 mg/kg/day; 3 doses) were used to treat PDA depending on clinical and hemodynamic status. Data on demographic characteristics, PDA status, use of indomethacin, and outcome factors such as chronic lung disease and mortality were collected. RESULTS: A total of 166 infants were identified in the study period, of which 15 were excluded. The median gestation was 27 weeks [IQR (25, 28)] and the mean (SD) birthweight was 950 (244) grams. The remaining infants (n=151) were divided into three groups. Group1 (n=47): no or non-significant PDA, Group 2 (n=91): significant PDA closed after indomethacin treatment (= 1 course) and Group 3 (n=13): significant PDA not responding to indomethacin. The closure rate of PDA with indomethacin treatment (group 2) was 87%. A low gestational age < 26 weeks (OR 5.6, 95% CI 1.6-19.9) and female sex (OR 5.8, 95% CI 1.5-22.8) was associated with poor response to indomethacin in our study population. CONCLUSIONS: Multiple indomethacin courses using the standard dosing approach result in high PDA closure rates for infants < 29 weeks gestation.

Quantitative analysis of facial movement--a review of three-dimensional imaging techniques.

Objective analysis of facial movement forms an important consideration in the assessment and outcome of several medical disciplines. Technological advances in the field of medical imaging have meant techniques to measure facial movement have evolved from subjective grading scales to facial-marker-based tracking systems to the most recent development of true three-dimensional marker-free systems. The aim of this paper is to provide a comprehensive review of the literature in this evolving field of medical imaging particularly focusing on three-dimensional analysis of facial movement and outlining the current concepts in objective analysis of the data set.

Three-dimensional motion analysis - an exploratory study. Part 2: reproducibility of facial movement.

OBJECTIVES: To investigate the reproducibility of using spoken word as a measure of facial movement. DESIGN: Experimental study. SETTING AND SAMPLE POPULATION: Department of Dental Health and Biological Sciences, University Dental Hospital, Cardiff. 22 normal subjects. EXPERIMENTAL VARIABLE: Subjects were asked to say the word 'puppy' in a normal, relaxed manner twice within a 10-second time interval. The sequence was recorded using a non-invasive, three-dimensional motion analysis image capture system (3DMDface Dynamic System) at 48 frames per second. OUTCOME VARIABLE: Corresponding frames between the two utterances were aligned three-dimensionally using best fit on non-moveable points on the upper half of the face. Reproducibility was measured as the percentage point deviation between +/- 0.5 mm between two corresponding frames. RESULTS: Mean intrasessional reproducibility (SD) for the group was recorded at 86.2% (5.8). The reproducibility ranged from a minimum of 66.8% to a maximum of 97.5%. When the utterance was split into its two separate viseme segments (/p//u//p/ and /p//y/), the second part of the utterance was seen to be more reproducible than the first. The male group were more reproducible than the female group. CONCLUSION: Intrasessional reproducibility of the utterance 'puppy' shows high intra- and intersubject variability in this group of normal subjects and therefore further research needs to be conducted before being able to confidently use this word as a reproducible measure of facial movement.

Three-dimensional motion analysis - an exploratory study. Part 1: assessment of facial movement.

OBJECTIVES: To objectively quantify facial movement in response to facial expression and spoken word. DESIGN: Experimental study. Setting - Department of Dental Health and Biological Sciences, University Dental Hospital, Cardiff, UK. EXPERIMENTAL VARIABLE: Facial movement was assessed in response to a standardized smile expression and the utterance 'puppy'. The sequences were recorded using a non-invasive, three-dimensional motion analysis image capture system (3dMDface Dynamic System) at 48 frames per second. OUTCOME VARIABLE: To quantify the facial movement, sequential frames of a sequence were aligned to the baseline/reference frame three-dimensionally using best fit on non-moveable points in the upper half of the face. Accuracy of the alignment process for each sequence was tested using the percentage of stable points (i.e. within +/-0.5 mm) within the upper half of the face. RESULTS: Quantifiable changes in facial topology were seen during both the standardized smile expression and the utterance 'puppy'. The mean percentage of points (SD) that remained stable within the upper half of the face during the utterance 'puppy' was 88.8% (4.7). During the standardized smile expression, there were a much lower percentage of stable points in the upper half of the face with a mean (SD) of 60.9% (3.2). CONCLUSION: The 3dMDface Dynamic System allows objective, three-dimensional, non-invasive assessment of facial movement. The utterance 'puppy' is a more appropriate measure of facial movement when compared with the standardized smile expression.

Mid-line clefts of the cervical vertebrae - an incidental finding arising from cone beam computed tomography of the dental patient.

Cone beam computed tomography (CBCT) is a rapidly emerging imaging modality in dentistry that offers the advantages of high diagnostic yield with short scanning times and a radiation dose significantly lower than conventional CT. Clinical applications of CBCT are numerous and they are being used both within the hospital and the primary care setting. The need for complete interpretation of CBCT images is essential. This report presents two patients for whom CBCT was carried out for orthodontic related purposes and incidental findings of cervical vertebrae clefts diagnosed. CBCT wherever they are undertaken should be reported by someone who has undergone adequate training in their interpretation particularly when machines using a large field of view are employed.

Improving cross-cultural awareness. A review of Australian indigenous health for UK dentists.

OBJECTIVE: The aim of this paper is to give an insight into the unique health issues faced by the indigenous population of Australia and their direct relationship to oral health, to help overseas dentists wishing to work in Australia to treat these groups of patients successfully and effectively. This applies equally to indigenous Australians living in remote Australia as well as to those living in general suburbia. DATA SOURCES: A Medline search was carried out for any articles in dental and medical journals pertaining to Australian indigenous health and Australian oral health. DATA SELECTION: Wherever possible, articles cited were obtained in full and where this was not possible, abstracts were obtained. Where no abstract was available, the article was not considered for evaluation. DATA EXTRACTION: Articles were reviewed by a single observer and were subject to meeting inclusion criteria indicated in the review. DATA SYNTHESIS: Articles were divided into historical, diet, oral health and general health categories. Subjective descriptions were then made. CONCLUSIONS: The adoption of a 'westernised' diet by the Australian indigenous community has placed them as a high risk population for dental caries and periodontal disease. They also show some of the highest rates in the world for Non-Insulin Dependent Diabetes Mellitus (NIDDM) and Rheumatic Fever. The UK dentist should be aware of these health issues and their relationship to indigenous oral health before embarking on work within Australia.

Blindness following retrobulbar haemorrhage--it can be prevented.

Delay in diagnosis and treatment of an elderly woman with a malar fracture that caused retrobulbar haemorrhage resulted in complete loss of vision in the right eye.

Patent Ductus Arteriosus in Infants <29 Weeks Gestation – Outcomes and Factors Affecting Closure.

Objective: To determine Patent ductus arteriosus (PDA) closure rates for extremely preterm infants in a tertiary care centre, factors affecting response to indomethacin and outcomes of these infants relative to their PDA status. Setting: Neonatal intensive care unit in tertiary-care children’s hospital. Design: Retrospective medical record review. Methods: A retrospective chart review of all infants <29 weeks gestation between 1st Jan 2003 and 30th June 2006 was carried out. Multiple courses of standard intravenous indomethacin (dose: 0.2 mg/kg 12 hourly; 3 doses) followed by a tail course (0.1 mg/kg/day; 3 doses) were used to treat PDA depending on clinical and hemodynamic status. Data on demographic characteristics, PDA status, use of indomethacin, and outcome factors such as chronic lung disease and mortality were collected. Results: A total of 166 infants were identified in the study period, of which 15 were excluded. The median gestation was 27 weeks [IQR (25, 28)] and the mean (SD) birthweight was 950 (244) grams. The remaining infants (n=151) were divided into three groups. Group1 (n=47): no or non-significant PDA, Group 2 (n=91): significant PDA closed after indomethacin treatment (≥ 1 course) and Group 3 (n=13): significant PDA not responding to indomethacin. The closure rate of PDA with indomethacin treatment (group 2) was 87%. A low gestational age < 26 weeks (OR 5.6, 95% CI 1.6-19.9) and female sex (OR 5.8, 95% CI 1.5- 22.8) was associated with poor response to indomethacin in our study population. Conclusions: Multiple indomethacin courses using the standard dosing approach result in high PDA closure rates for infants < 29 weeks gestation.