Bitewing radiography dosimetry of the PORTRAY stationary-intraoral tomosynthesis imaging system.

OBJECTIVE: This study measured effective (E) and equivalent doses from adult and child 3-dimensional (3D) and 2D posterior bitewing (PBW) examinations using the PORTRAY stationary-intraoral tomosynthesis radiography system. STUDY DESIGN: Adult and child phantoms and optically stimulated luminescent dosimeters were used to measure doses for adult-4 and child-2 projection PBW examinations acquired without (W/O) and with (W) a direct digital sensor in the beam path. Child doses without and with thyroid shielding were measured. RESULTS: Three-dimensional examination E values (µSv) W/O and W were 16.7 and 7.3 for adult, 9.2 and 3.5 for child, and 8.7 and 3.0 with thyroid shielding, respectively. Two-dimensional examination E values W/O and W were 4.3 and 1.5 for adult, 2.1 and 0.6 for child, and 2.0 and 0.5 with shielding, respectively. Sensor presence reduced E for all adult and child examinations (P = .0001). Child E was reduced compared with adult E for both sensor conditions in 3D (P < .0001) and 2D (P ≤ .0043) imaging. Adult and child 3D W/O and W equivalent thyroid doses did not differ (P ≥ .9996). However, child 2D W/O and W doses were lower (P ≤ .0002). Shielding produced no reduction (P ≥ .1128) for either 3D condition or 2D with the sensor (P = .6615) but reduced child 2D dose without the sensor. CONCLUSIONS: Inclusion of a sensor yielded significant reductions in adult and child E. Sensor presence impacted thyroid dose reduction more than shielding.

Comparison of a full arch digital photographic assessment of caries prevalence in 5-year-old children to an established visual assessment method: a cross-sectional study.

INTRODUCTION: Digital epidemiology in dental disease screening has a number of advantages which warrant further exploration. AIM: This study aimed to test the examination accuracy of digital images to evaluate child oral health by comparing the new method to a gold standard method. It also investigated the levels of diagnostic accuracy between different examiners, including dental care professionals and a lay examiner, when quantifying dental disease using images. METHODS: A calibrated dental examiner inspected forty 5-year-olds. In addition, three sets of digital images were taken per child. These images were assessed by six examiners. Sensitivity and specificity of caries diagnosis and inter-examiner reliability were calculated to compare the caries scores derived from examination of the images to those of the gold standard examinations. RESULTS: The mean values for sensitivity and specificity scores were 48.0% and 99.1%, respectively. The mean value for kappa showed moderate agreement between 0.43 and 0.73 (0.57). Mean values for agreement using intra-class coefficients were excellent (0.78) and good (0.73) for dt and dmft, respectively. No statistical difference in the validity of the caries scores was shown between the different image assessors. CONCLUSIONS: These data demonstrate the feasibility of using digital images to screen child oral health and for nondental professionals to be recruited to carry out digital epidemiology for the oral health surveillance of children.

Which type of soft tissue augmentation at dental implant sites is best supported by evidence?

Data sources PubMed, the Cochrane Oral Health Group Trials Register and Embase. Additionally, issues of the following journals between 2000 and April 2019 were hand-searched: Journal of Clinical Periodontology, Journal of Periodontology, International Journal of Periodontology and Restorative Dentistry, European Journal of Oral Implantology, Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, and Clinical Oral Implants Research.Study selection Only randomised controlled trials (RCTs) involving soft tissue augmentation at dental implant sites were considered for inclusion. The selection was restricted to RCTs published in English language with at least ten patients per group and a minimum follow-up period of three months. A PICO method was used to organise the inclusion criteria and soft tissue augmentations were clustered into three groups; that is, before prosthetic treatment, after prosthetic treatment and at immediate implant placement.Data extraction and synthesis The screening of titles and abstracts was carried out by two reviewers and disagreements were moderated by a third reviewer. Eligibility was determined using full texts and data were extracted using purposefully designed forms. The Cochrane handbook for systematic reviews of interventions toolkit was used to assess the risk of bias. The studies were grouped according to the type of intervention and subjected to quantitative data synthesis. Continuous outcome measures were assessed using random-effects meta-analyses and pooled estimates were expressed as weighted mean differences (MDs) along with 95% confidence intervals (CIs).Results Following initial electronic and hand-searches, 2,119 studies were screened for title and abstract, and 32 studies were considered for full-text screening. Only 14 RCTs met the inclusion criteria and the remaining 18 studies were excluded from the systematic review. The included studies described soft tissue augmentation for 538 implants placed in 475 patients. Three studies (68 patients; 78 implants) reported improved soft tissue thickness with xenogenic collagen matrix (XCM) augmentation compared to no augmentation at the implant sites before prosthetic treatment (high/unclear risk of bias). One study (28 patients; 41 implants) reported improved height of keratinised tissue (KT) and marginal bone levels (MBLs) with free gingival graft (FGG) compared to no augmentation at the implant sites after prosthetic treatment (unclear risk of bias). Three RCTs (126 patients; 126 implants) focused on connective tissue grafting (CTG) and bone grafting versus no grafting in conjunction with immediate implant placement after tooth extraction (unclear risk of bias). There was no difference in MBLs in any of the studies, while one study showed superior soft tissue thickness (STT). Four RCTs (129 patients; 133 implants) compared different augmentation techniques before prosthetic treatment. Only one study showed improved STT with CTG compared to XCM (low risk of bias). Finally, three RCTs (124 patients; 160 implants) compared different augmentation techniques after prosthetic treatment (high/unclear risk of bias). FGG was observed to be superior to acellular dermal matrix (ADM) and vestibuloplasty to improve KT. Meta-analyses did not favour CTG to improve MBLs at extraction sites but CTG was superior to XCM to improve STT before prosthetic treatment.Conclusions Notwithstanding the limitations of the systematic review, soft tissue augmentation significantly enhances the amount of soft tissue at the implant site. CTG at the extraction site also improves subsequent bone level of the implants. Moreover, CTG before prosthetic treatment is superior to XCM to improve thickness of peri-implant soft tissues. However, these findings are based on short-term follow-up and future studies with improved methodology are required to establish the long-term benefits of soft tissue augmentation at the dental implant sites.

Strategies to improve oral health behaviours and dental access for people experiencing homelessness: a qualitative study.

Objectives The present study aimed to identify strategies to improve oral health behaviours as well as access to and provision of dental care for people experiencing homelessness.Method We conducted focus groups with people living in a residential homeless centre and semi-structured interviews with other stakeholders working with or supporting people experiencing homelessness. Following an inductive approach, thematic analysis was used to synthesise the findings on NVivo software.Results Participants included 11 British males experiencing homelessness and 12 other stakeholders from various professional backgrounds. Themes identified included: awareness and empowerment; supportive environment and dental health system; flexible and holistic care; outreach and community engagement; collaboration with other health and social services; and effective communication.Conclusions Efforts to improve oral health among people experiencing homelessness via improved oral health habits and engagement with services need to be directed at both the recipients of care and the healthcare teams. Well-powered empirical studies are needed to evaluate whether the strategies identified can improve engagement and care provision for this population.

What are the long-term survival and complication rates of complete-arch fixed implant rehabilitation in edentulous patients?

Cohort selection The study cohort was selected through screening of electronic records of all patients rehabilitated with interforaminal implants and implant-supported fixed complete dental prostheses (IFCDPs) over an 11-year period at the Tufts University School of Dental Medicine. Evaluation was based on medical and dental history; clinical oral examination of hard and soft tissues; and radiographic examination during a single visit.Data analysis Survival and failure rates of implants and prostheses were recorded based on predefined criteria. Along with descriptive statistics, the observed annual incidence, and the estimated five- and ten-year biologic and technical complications were computed with 95% confidence intervals.Results The study cohort included 41 patients with an average age of 65.8 years (range = 39 to 88 years) and comprised 19 females and 22 males. A total of 359 moderately rough surface dental implants (Nobel Biocare, Straumann, Biomet 3i) were used to rehabilitate 36 cement-retained and 19 screw-retained metal-ceramic IFCDPs in maxilla (N = 32) mandible (N = 23). The mean observation times for implants and prostheses were 5 and 7.5 years, respectively. Two implant failures in a single patient were recorded 11 years post-insertion, yielding an implant survival rate of 99.4%. The cumulative prostheses survival rate was 98.2% (100% at five years and 92.9% at ten years). Biologic and/or technical complications were associated with all 55 prostheses. Among major complications, the most frequent biologic complication was peri-implantitis while porcelain fractures were the most common technical complication. The cumulative rates of 'prostheses free of biologic complications' were 50.4% (95% CI: 36.4% to 63.0%) at five years and 10.1% (95% CI: 3.5% to 20.8%) at ten years. The cumulative rates for 'prosthesis free of technical complications' were 56.4% (95% CI: 41.7% to 68.8%) at five years and 9.8% (95% CI: 3.2% to 21.0%) at ten years.Conclusions Metal-ceramic implant-supported fixed full arch dental prostheses show high survival rates at five-year follow-up, including an implant survival rate of 99.4% and prosthesis survival rate of 98.2%. However biological and technical complications were observed in 47.1% and 42%, respectively.

'Teeth Matter': engaging people experiencing homelessness with oral health promotion efforts.

People with experience of homelessness commonly suffer from poor oral health and are likely to have low-level engagement with dental services. 'Teeth Matter' was a pilot study developed to examine whether peer education could result in improved plaque management among people who are experiencing homelessness. Based on the experience gained from developing and implementing the study, and taking into consideration the views of everyone involved, this paper provides a list of suggestions and resources that can be used to improve engagement of this population with oral health promotion activities. Some of the learning points are also applicable in the clinical setting.

A qualitative exploration of promoting oral health for infants in vulnerable families.

Introduction Oral disease in very young children is far more common among children in deprived and vulnerable families than among their peer group. Such children are at the highest risk of requiring a general anaesthetic for removal of decayed primary teeth.Aim This study aimed to create new knowledge about how best to promote oral health among a target population, about who very little is established with regard to how to successfully intervene to improve long-term oral health.Method Phase one of the study developed a logic model, and phase two delivered an oral health-promoting intervention by working with the Family Nurse Partnership. The social and empirical acceptability of the intervention was explored, and the attributes needed by people delivering such an intervention were investigated in-depth.Results The thematic analysis of phase one data produced seven key themes which appeared to influence parents' ability and willingness to accept an oral health intervention aimed at their infants. These were: their personal experiences, current oral health knowledge, desire for dental care for their child, the timing of an intervention, their perception of difficulties, family norms and the level of trust developed.Conclusion It is possible to motivate the most vulnerable families to establish behaviours which are conducive to good oral health, and that intervention is feasible and appropriate if a trusting relationship is adopted by the deliverer of the intervention. Families were successful in adopting oral health behaviours and visiting dental services when such circumstances were established.

Management of plaque in people experiencing homelessness using 'peer education': a pilot study.

Introduction People who experience homelessness have poor oral health and limited access to dental services.Aim To examine whether 'peer education' could yield improved plaque management among people experiencing homelessness.Methods A quasi-experimental, one-group pre-test-post-test study was conducted, with follow-up at one and two months. Participants were living in temporary accommodation in Plymouth, UK. Plaque levels were assessed using the simplified oral hygiene index. A questionnaire and the oral health impact profile (OHIP-14) were administered. Patient satisfaction and barriers to dental care were explored by interviews.Results The baseline sample included 24 people with a mean age of 36.88 ± 10.26 years. The mean OHIP-14 score was 25.08 ± 19.56; finding it uncomfortable to eat and being embarrassed attracted the highest values (2.46 ± 1.53 and 2.33 ± 1.63, respectively). Plaque levels decreased by month one and month two, though the changes were not statistically significant. Positive changes in confidence in toothbrushing at month two were identified (p = 0.01).Conclusion Experiencing pain and the opportunity to access treatment were key drivers of study participation. The study indicated that it is feasible to conduct oral health promotion projects for people in temporary accommodation. Adequately powered studies examining the impact of peer education on improving homeless people's oral health are warranted.