Evidence that ectopic upper third molars can result in upper second molar impactions: A case series.

INTRODUCTION: The aim of these four case reports was to illustrate the presence of potential upper second molar impactions associated with ectopic third molars and to highlight that some cases have an atypical radiographic presentation. CASE PRESENTATIONS: Four patients (age range = 7-12 years) with various malocclusions presented to the paediatric and orthodontic departments for treatment to address their presenting complaints. Incidental radiographic findings demonstrated potentially impacted upper second molars associated with ectopic third molars. In all of these cases, a joint paediatric-orthodontic approach was adopted to address their dental health, prevent upper second molar impaction and to treat their malocclusion. DISCUSSION: Careful and systematic review of radiographic imaging was necessary in order to correctly diagnose these cases. These cases demonstrated that it was not always simple to determine impactions, particularly as identification of third molar crypts can be difficult. On occasion, sequential radiographical monitoring is advocated, particularly in patients in the mixed dentition; however, clinicians must be mindful of the risks of ionising radiation as it is not routine practice to irradiate a patient multiple times. CONCLUSION: The series of cases highlights the need for a systematic assessment of OPTs to identify ectopic upper third molars. The input from radiologists is invaluable and if necessary, supplemental three-dimensional cone-beam computed tomography can be performed.

An environmental impact study of inter-dental cleaning aids.

AIM: The aim of this study was to compare the environmental footprint of eight inter-dental cleaning aids. MATERIALS AND METHODS: A comparative life cycle analysis was conducted based on an individual person using inter-dental cleaning aids every day for 5 years. The primary outcome was a life cycle impact assessment. This comprised of 16 discrete measures of environmental sustainability (known as impact categories), for example, greenhouse gas emissions (measured in kilograms of carbon dioxide equivalent, or kg CO2 e), ozone layer depletion (measured in kilograms of chloroflurocarbon equivalent, or kg CFCe), and water use (measured in cubic metres). Secondary outcomes included normalized data, disability-adjusted life years, and contribution analysis. RESULTS: Inter-dental cleaning using floss picks had the largest environmental footprint in 13 of 16 impact categories. Depending on the environmental impact category measured, the smallest environmental footprint came from daily inter-dental cleaning with either bamboo inter-dental brushes (five impact categories, including carbon footprint), replaceable head inter-dental brushes (four impact categories), regular floss (three impact categories), sponge floss (three impact categories), and bamboo floss (one impact category). CONCLUSIONS: Daily cleaning with inter-dental cleaning aids has an environmental footprint that varies depending on the product used. Clinicians should consider environmental impact alongside clinical need and cost when recommending inter-dental cleaning aids to patients.

The environmental impact of community caries prevention - part 1: fluoride varnish application.

Background Healthcare is a significant contributor to climate change and planetary health. Prevention of oral disease, such as caries, is an important part of any mechanism to improve sustainability. Caries prevention includes community schemes such as water fluoridation, toothbrushing, or fluoride varnish (FV) application. The aim of this study was to quantify the environmental impact of FV application.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of a five-year-old child receiving two FV applications in a one-year period in schools and in dental practice.Results FV application in dental practice during an existing appointment had the lowest environmental impact in all 16 categories, followed by FV application in schools. FV application at a separate dental practice appointment had the highest impact in all categories, with a majority of the impact resulting from the patient travel into dental practice.Discussion FV application while a child is already attending dental practice (for example, at routine recall) is the most sustainable way to deliver FV. School FV programmes are an alternative, equitable way to reach all children who may not access routine care in dental practice.

The environmental impact of community caries prevention - part 2: toothbrushing programmes.

Introduction Community-level caries prevention programmes includes supervised toothbrushing in schools and the provision of toothbrushes and toothpaste. The environmental impact of these interventions is an important factor to consider when commissioning these services.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of a five-year-old child receiving one of two toothbrushing programmes over a one-year period; supervised toothbrushing in school, or the provision of toothbrushes and toothpaste.Results Supervised toothbrushing had a lower environmental impact than provision of toothbrushes and toothpaste in all 16 impact categories measured. The water use needed for children to brush their teeth was the greatest contributing factor to the provision of toothbrushes and toothpaste, accounting for an average of 48.65% of the impact results.Discussion All community-level caries prevention programmes have an associated environmental cost. LCA is one way to quantify the environmental impact of healthcare services and can be used along with cost and clinical effectives data to inform public healthcare policy. Organisations responsible for these programmes could use the results of this study to consider ways to reduce the environmental impact of their services.

The environmental impact of community caries prevention - part 3: water fluoridation.

Introduction Community-level interventions for the prevention of dental caries in children include fluoride varnish in schools, supervised toothbrushing in schools, the provision of toothbrushes and toothpaste and water fluoridation. The environmental impact of these interventions is an important factor to consider when commissioning these services.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of fluoridation of the public water supply for a five-year-old child over a one-year period. These results were compared to LCA data for fluoride varnish in schools, supervised toothbrushing and the provision of toothbrushes and toothpaste.Results When comparing community-level caries prevention programmes, water fluoridation had the lowest environmental impact in all 16 categories and had the lowest disability-adjusted life years impact.Discussion All community-level caries prevention programmes have an associated environmental cost. Water fluoridation performed well in this LCA study in all measures of environmental sustainability. The results of this study could be used, along with cost and clinical effectiveness data, to inform public healthcare policy.

Comparing the environmental impact of reusable and disposable dental examination kits: a life cycle assessment approach.

Introduction The global climate crisis has increased the emphasis placed on the sustainability and environmental consequences of our actions. The dental examination accounts for a large portion of dentistry's carbon footprint, more specifically, the production, sterilisation, transport, use and disposal of the dental examination kit. An attributional life cycle assessment (LCA) was carried out to compare the impact of a reusable stainless-steel examination kit and that of a disposable plastic examination kit.Materials and methods All inputs, outputs and processes across the life cycle were accounted for using Ecoinvent database v3.7.1 and openLCA software. Impacts were considered across 16 European-recommended environmental impact categories and eight human health impact categories.Results The disposable kit performed worse across all categories of ecological and human health harm. Categories with most notable impact were climate change, metal-mineral and fossil fuel resource depletion and water scarcity. Impacts were primarily attributable to material processing, instrument production and sterilisation procedures.Conclusion Healthcare is responsible for a significant proportion of greenhouse gas emissions. The single-use examination kit poses greater ecological and human health threat than does the reusable examination kit; this aligns closely with related research in the field. The dentist seeking to adopt more environmentally-conscientious practices should consider using a reusable, stainless-steel examination kit.

Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences?

In order to reduce the transmission of pathogens, and COVID-19, WHO and NHS England recommend hand washing (HW) and/or the use of hand sanitizer (HS). The planetary health consequences of these different methods of hand hygiene have not been quantified. A comparative life cycle assessment (LCA) was carried out to compare the environmental impact of the UK population practising increased levels of hand hygiene during the COVID-19 pandemic for 1 year. Washing hands with soap and water was compared to using hand sanitizer (both ethanol and isopropanol based sanitizers were studied). The isopropanol-based HS had the lowest environmental impact in 14 out of the 16 impact categories used in this study. For climate change, hand hygiene using isopropanol HS produced the equivalent of 1060 million kg CO2, compared to 1460 million for ethanol HS, 2300 million for bar soap HW, and 4240 million for liquid soap HW. For both the ethanol and isopropanol HS, the active ingredient was the greatest overall contributing factor to the environmental impact (83.24% and 68.68% respectively). For HW with liquid soap and bar soap, there were additional contributing factors other than the soap itself: for example tap water use (28.12% and 48.68% respectively) and the laundering of a hand towel to dry the hands (10.17% and 17.92% respectively). All forms of hand hygiene have an environmental cost, and this needs to be weighed up against the health benefits of preventing disease transmission. When comparing hand sanitizers to handwashing with soap and water, this study found that using isopropanol based hand sanitizer is better for planetary health. However, no method of hand hygiene was ideal; isopropanol had a greater fossil fuel resource use than ethanol based hand sanitizer. More research is needed to find hand hygiene sources which do not diminish planetary health, and environmental impact is a consideration for public health campaigns around hand hygiene.

Patient-reported outcome measure for children and young people with amelogenesis imperfecta.

Background Amelogenesis imperfecta (AI) is a genetic enamel defect that can affect both the primary and permanent dentition. It has a range of clinical phenotypes, and children and young people often present with challenging oral health needs. Patient-reported outcome measures (PROMs) can identify key patient concerns.Methods This was a multi-centre service evaluation across several specialist paediatric dentistry services in the UK. A PROM questionnaire was created with clinician and patient input, through peer review with the national AI Clinical Excellence Network, as well as piloting the PROM with ten children and young people with AI. The final PROM questionnaire was distributed to all patients with AI attending each unit between January and March 2020.Results Sixty children and young people (aged 5-17 years) across four specialist units participated, with 72% reporting that they 'often' or 'sometimes' experienced pain or sensitivity and 76% reporting that they 'often' or 'sometimes' felt unhappy with the way their teeth look. Of the patients who were post-treatment, 81% indicated that they were happy with their teeth, compared to just 41% of patients who were mid-treatment and 33% of patients who were pre-treatment.Conclusion Children and young people with AI experience a range of issues related to their function and psychosocial wellbeing. This simple PROM demonstrates the range of issues this group of patients face, and could be used to monitor an individual's progress to ensure that treatment is planned to address the patient's individual concerns and needs.

Webinars reduce the environmental footprint of pediatric cardiology conferences.

BACKGROUND: Webinars have recently replaced in-person medical conferences, including paediatric cardiology conferences, given the COVID-19 pandemic. METHODS: With increasing environmental concerns, we analysed the differences between the environmental footprint of a paediatric cardiology webinar with a hypothetical conference. Travel data was collected, with assumptions made on the amount of computer use, internet use and accordingly the overall use of electricity for both forms of conference. Life Cycle Assessment methodology was used (OpenLCA and Ecovinvent v 3.7). RESULTS: We showed that the theoretical environmental impact of a virtual conference is significantly less (4 tons CO2 equivalent) than the traditional international face-to-face conference (192 tons CO2 equivalent). The life cycle assessment methodology showed that resource use for a face-to-face conference lasting 2.5 days for 1374 attendees is equivalent to 400 times what an average person would use in one year, the climate change and photochemical ozone formation approximately 250 times and the eutrophication terrestrial equivalent to 225 times. However, using carbon equivalent emissions to measure environmental harm from flying is an under estimate of the potential damage, when one considers the additional production of airplane contrails. Notwithstanding this, there is a 98% reduction in climate change impact when meetings are held virtually. CONCLUSIONS: While the virtual conference may never completely replace the traditional in-person paediatric cardiology conference, due to networking benefits, the significant theoretical benefits to the environment highlighted in this study, warrants consideration for the virtual conference taking a more common place in sustainable academia.

Service evaluation of an intravenous sedation service within a hospital paediatric dentistry unit: ten-year results.

Background An intravenous sedation (IVS) service was established in 2008 for young people aged 12 years or over, within the paediatric dentistry department at the Eastman Dental Hospital in London. The aim of this study was to carry out a service evaluation and assess the case mix and success rate of this service over the last ten years.Materials and methods A retrospective service evaluation was carried out, including all patients attending the IVS clinic between April 2009 and March 2019.Results A total of 457 patients attended over 525 appointments. The mean age was 14. The success rate was over 98%. The average dose of midazolam was 4 mg and dosage ranged from 1.5-10 mg.Conclusion This IVS service has been established successfully and offers patients an alternative to general anaesthetic. This consequently reduced the general anaesthetic waiting list by 10%.

Incorporating sustainability into assessment of oral health interventions.

Prior to 1966, consumers purchased food items with very little (if any) nutritional labels. Now, nutritional labelling is an integral part of informed consumer choice. This paper advocates for a similar approach for healthcare-related products, using the toothbrush as an example, with the need to quantify and publish data on their clinical efficacy and environmental impact. In this paper, we consider different manufacturing models and measure the environmental impact (carbon footprint) and also the human health impact (disability-adjusted life years [DALYs]) for the most commonly used oral health product: the toothbrush.

Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model.

Introduction Healthcare professionals should consider environmental sustainability when recommending medical devices to patients, although there is currently little quantitative data available. The toothbrush is a widely recommended healthcare device worldwide. The aim of this study was to compare the sustainability of different types of toothbrush.Materials and methods Four types of toothbrush were studied: a traditional plastic and electric toothbrush, as well as a plastic manual toothbrush with replaceable heads and a bamboo manual toothbrush. Life cycle assessment (LCA) methodology was applied to quantify the environmental impact of these toothbrushes over five years.Results The electric toothbrush performed consistently poorly compared to the three manual toothbrush types and had the greatest impact in 15 out of 16 environmental categories. The bamboo and replaceable-head plastic toothbrushes had the lowest impact in all categories. The climate change potential of the electric toothbrush was 11 times greater than the bamboo toothbrush.Discussion Switching toothbrushes from the traditional toothbrushes to bamboo or replaceable-head plastic is more environmentally sustainable. These results could be used to inform individual consumer choice, oral health recommendations, procurement of toothbrushes for public health programmes and toothbrush manufacturers. LCA methodology can be used to make healthcare more sustainable.

Mucosal pigmentation of the hard palate in a patient taking imatinib.

Imatinib mesylate is used in the treatment of chronic myeloid leukaemia, among other conditions. Oral mucosal pigmentation as a side effect is rare. We present a summary of the current literature and a case report of a 58-year-old Caucasian woman who presented with a diffuse blue-grey pigmentation of the palatal mucosa, thought to be related to long-term use of imatinib mesylate.