The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review.

Background: The sub-Saharan Africa has the fastest rate of urbanisation in the world. However, infrastructure growth in the region is slower than urbanisation rates, leading to inadequate provision and access to basic services such as piped safe drinking water. Lack of sufficient access to safe water has the potential to increase the burden of waterborne diseases among these urbanising populations. This scoping review assesses how the relationship between waterborne diseases and water sufficiency in Africa has been studied. Methods: In April 2020, we searched the Web of Science, PubMed, Embase and Google Scholar databases for studies of African cities that examined the effect of insufficient piped water supply on selected waterborne disease and syndromes (cholera, typhoid, diarrhea, amoebiasis, dysentery, gastroneteritis, cryptosporidium, cyclosporiasis, giardiasis, rotavirus). Only studies conducted in cities that had more than half a million residents in 2014 were included. Results: A total of 32 studies in 24 cities from 17 countries were included in the study. Most studies used case-control, cross-sectional individual or ecological level study designs. Proportion of the study population with access to piped water was the common water availability metrics measured while amounts consumed per capita or water interruptions were seldom used in assessing sufficient water supply. Diarrhea, cholera and typhoid were the major diseases or syndromes used to understand the association between health and water sufficiency in urban areas. There was weak correlation between the study designs used and the association with health outcomes and water sufficiency metrics. Very few studies looked at change in health outcomes and water sufficiency over time. Conclusion: Surveillance of health outcomes and the trends in piped water quantity and mode of access should be prioritised in urban areas in Africa in order to implement interventions towards reducing the burden associated with waterborne diseases and syndromes.

A cross-sectional ecological analysis of international and sub-national health inequalities in commercial geospatial resource availability.

BACKGROUND: Commercial geospatial data resources are frequently used to understand healthcare utilisation. Although there is widespread evidence of a digital divide for other digital resources and infra-structure, it is unclear how commercial geospatial data resources are distributed relative to health need. METHODS: To examine the distribution of commercial geospatial data resources relative to health needs, we assembled coverage and quality metrics for commercial geocoding, neighbourhood characterisation, and travel time calculation resources for 183 countries. We developed a country-level, composite index of commercial geospatial data quality/availability and examined its distribution relative to age-standardised all-cause and cause specific (for three main causes of death) mortality using two inequality metrics, the slope index of inequality and relative concentration index. In two sub-national case studies, we also examined geocoding success rates versus area deprivation by district in Eastern Region, Ghana and Lagos State, Nigeria. RESULTS: Internationally, commercial geospatial data resources were inversely related to all-cause mortality. This relationship was more pronounced when examining mortality due to communicable diseases. Commercial geospatial data resources for calculating patient travel times were more equitably distributed relative to health need than resources for characterising neighbourhoods or geocoding patient addresses. Countries such as South Africa have comparatively high commercial geospatial data availability despite high mortality, whilst countries such as South Korea have comparatively low data availability and low mortality. Sub-nationally, evidence was mixed as to whether geocoding success was lowest in more deprived districts. CONCLUSIONS: To our knowledge, this is the first global analysis of commercial geospatial data resources in relation to health outcomes. In countries such as South Africa where there is high mortality but also comparatively rich commercial geospatial data, these data resources are a potential resource for examining healthcare utilisation that requires further evaluation. In countries such as Sierra Leone where there is high mortality but minimal commercial geospatial data, alternative approaches such as open data use are needed in quantifying patient travel times, geocoding patient addresses, and characterising patients' neighbourhoods.

UCLan School of Dentistry prepares its first graduates.

The new School of Dentistry at the University of Central Lancashire (UCLan) opened on 3 September 2007 and was the first dental school to be built in Britain for many years. This September the School will be complete with all four years of students and the first students will be applying for their vocational trainee positions this autumn. This article reflects on its successful programme and describes how UCLan's School of Dentistry differs from traditional dental schools.

The use of objective digital matching to achieve an esthetic composite restoration.

OBJECTIVE: To investigate the ability to match composite restorations to teeth using digital imaging and CIE L*a*b* color differences. METHODS: Ten extracted human central incisors were used. Eleven discs of composite of differing shades were produced and mounted on white cardboard to create a customized shade guide (CSG). The CSG was photographed next to each of the ten teeth in a phantom head using a digital SLR camera. The images were analyzed, and color differences (deltaE) between the teeth and the shade discs were calculated using CIE L*a*b* values. Three cavities were then drilled into the labial surface of each tooth. Composite shades with the lowest three deltaE values were then used to restore the cavities. Ten observers evaluated the teeth under a standard D65 light source and recorded the best match. RESULTS: The majority of the observers selected the lowest deltaE in six out of the 10 teeth, and in a further two out of 10 teeth the second lowest deltaE was chosen. CONCLUSION: The lowest deltaE selected by objective color matching was agreed as the best match by observers. The high correlation between digital and visual color matching confirms the ability of digital camera and image analysis software to detect color differences.

Three body wear studies of five dental composites preconditioned in food simulating media.

Progressive three body wear up to 30 min for five dental composites (Concise, Heliomolar, Occlusin, P-30, Profile, TPH) stored for 9 months at 37 degrees C in citrate, lactate and PBS buffers, 25 and 75% ethanol media, has been measured using a wear tester. Particle size of the filler and the storage media are found to play dominant roles in determining the extent of wear. Heliomolar, which is a microfilled composite, shows maximum wear whereas wear is least in composites containing filler particles of conventional and hybrid size such as P-30 (> 1 micron). The storage media is found to attack and degrade glass filler particles compared to composites having quartz fillers.

Fluoride release from aesthetic dental materials.

The objective of the study was to compare the amounts of fluoride released by two glass-ionomer cements, a resin-modified glass-ionomer cement, a compomer and a fluoride-containing composite into deionized water and artificial saliva. Disc samples of each of the materials were fabricated and placed in either water or artificial saliva. Fluoride analysis of the media was performed periodically over 64 days. The data were analysed to show the rate of fluoride release per cm2 per hour for each material. The results showed that the fluoride release rate for all the materials in both solutions decreased dramatically after 24 h. The release rate in artificial saliva was significantly less than in water (P < 0.001). The resin-modified glass-ionomer cement consistently displayed the highest fluoride release rate per hour into both media.

Fluoride recharge of aesthetic dental materials.

The objective of the study was to compare the potential for fluoride recharge of two glass-ionomer cements, a resin-modified glass-ionomer cement, a compomer and a fluoride-containing composite in artificial saliva. Disc samples of each of the materials were placed into artificial saliva. The fluoride content of the artificial saliva was determined at various intervals up to 57 days. The discs were subjected to a 2 min exposure of NaF (500 parts/106). This recharge procedure was repeated at 64 and 120 days. The fluoride release was measured before and after recharge. The fluoride release for all of the materials increased after each exposure to NaF; however, the amount for the composite was very low. The resin-modified glass-ionomer cement displayed the greatest potential for fluoride recharge at 57 and 64 days (P<0.05). By 120 days, the amount of fluoride released in the 24 h post-recharge interval had decreased in all the materials. All the materials showed a potential for fluoride recharge. This effect, however, was minimal in the fluoride-containing composite.

Understanding wear in dentistry.

Tooth wear is an increasing problem in dentistry. Traditionally, it has been divided into three categories: abrasion, attrition, and erosion. However, most clinical cases of tooth wear involve more than one of these processes. It is often easier to make a diagnosis by looking for the signs of the fundamental wear processes rather than trying to categorize the individual case. Wear can be caused by direct surface-to-surface wear, an intervening slurry, or a corrosive environment. Wear occurs during mastication, but also at other times, often at night. Although it may be possible to institute a preventive regimen, this will not always help the patient if his or her prime concern is esthetics. The same processes that cause tooth wear will cause wear to restorative materials. To diagnose and prevent wear, its processes must be understood.

The silver sorption layer in dental composites: three year results.

OBJECTIVES: The purpose of this investigation was to observe the behaviour of a recently discovered silver sorption layer in seven dental composites for three years. METHODS: Rectangular block testpieces (3.0 x 2.5 x 2.5 mm) of seven resin composites were fabricated and the resin rich layer removed from one surface by grinding on silica carbide paper. The testpieces were immersed in aqueous AgNO3 (3 mol/l). After 26, 42, 90, 180, 360, 540, 720 and 1085 days, respectively, nine specimens of each material were removed to measure the depth of silver stain in the different composites. RESULTS: The depth of silver stain continued to increase at a rate proportional to (time)0.5. After three years, five homogeneous subsets [HS] were distinguished for the resin rich surface [HS1] Occlusin (stain depth = 45.6 microns); [HS2] Clearfil (117.8 microns), [HS3] Heliomolar (145.6 microns), Concise (148.8 microns), P-30 (168.9 microns); [HS4] Silux (243.3 microns); [HS5] Profile-TLC (446.7 microns). For the ground surface, the materials were in similar subsets but the depth of stain was less. Different coloured layers were seen within the sorption layer in some materials. SIGNIFICANCE: The linear relationship between the depth of stain and (time)0.5 indicate that the mechanism controlling the sorption is Case 1 (Fickian) diffusion. The different depths in the individual materials may indicate differences in the segmental mobility of the polymer chains and free space within the resin phase of the composites. If the silver sorption layer marks the extent of water penetration, then the results show different depth distributions for individual composites.

Ten-year clinical assessment of three posterior resin composites and two amalgams.

OBJECTIVE: The long-term clinical performance of three posterior resin composites and two amalgams was assessed. METHOD AND MATERIALS: Thirty Class II restorations each of P-30, Occlusin, Clearfil Posterior (composites), New True Dentalloy, and Solila Nova (amalgams) were placed. Reviews took place at 6 months and at 1, 2, 3, 4, 5, and 10 years. At each visit the gingival condition, the contact point status, and the presence of ledges, gaps, or recurrent caries were assessed. The color match, cavosurface marginal stain, general surface stain, tarnish, and corrosion were also scored where applicable. Epoxy resin replicas were used to measure the maximum depth of wear. RESULTS: After 10 years, there had been corrosion of both the high- and low-copper amalgams and a slight deterioration in color match of a number of composite restorations. Eighteen (of 20) Occlusin restorations had obvious cavosurface marginal stain, attributed to staining of the unfilled bonding resin layer. Statistical analysis indicated that New True Dentalloy, Solila Nova, and Clearfil-P exhibited significantly less wear than Occlusin and P-30. None of the restorations examined at the 10-year recall required replacement. CONCLUSION: The five materials, placed in a dental school environment, provided adequate clinical service for 10 years.

An association between the regular use of 3,4 methylenedioxy-methamphetamine (ecstasy) and excessive wear of the teeth.

AIMS: This study was established to determine if users of ecstasy had greater tooth wear than a comparison group of non-users. DESIGN: The study involved a direct comparison between two groups of young people gathered by a peer information network and divided by the response to the question "Do you take ecstasy?" SETTING: The information network was established at the Maryland Centre in Liverpool (UK). Besides offering advice on drug and sex-related problems this centre distributes free condoms and is therefore visited by many young people who would not consider themselves to have these problems. PARTICIPANTS: There were 30 users and 28 non-users with no significant difference in the gender ratio. Age was not recorded to maintain absolute confidentiality, but all the participants appeared to be of student age. MEASUREMENTS: Tooth wear was measured using the index of Smith & Knight. The social and drug-taking profile of the two groups was ascertained by questionnaire. FINDINGS: It was found that the mean (+/- STD) tooth wear score for the back teeth was 0.96 +/- 0.16 in the users compared with 0.12 +/- 0.08 for the comparison group. These values were significantly different (p < 0.001). The values for the front teeth were not significantly different. Many users were aware of clenching their teeth 12 or even 24 hours after taking the drug. CONCLUSION: Taking ecstasy results in an increased likelihood of tooth wear on the back teeth. This is likely to result from clenching the teeth in the acidic environment caused by carbonated (fizzy) drinks.

A clinical study of space closure with nickel-titanium closed coil springs and an elastic module.

A previous study has shown that a 150-gram nickel-titanium closed coil spring (Sentalloy, GAC International Inc.) closed spaces more quickly and more consistently than an elastic module (Alastik, Unitec/3M). This study used the same friction sensitive sliding mechanics of pitting the six anterior teeth against the second bicuspid and first molars, to examine the rate of space closure of 100-gram and 200-gram nickel-titanium closed coil springs. The results for the three springs and elastic module were compared. The nickel-titanium closed coil springs produced a more consistent space closure than the elastic module. The 150- and 200-gram springs produced a faster rate of space closure than the elastic module or the 100-gram spring. No significant difference was noted between the rates of closure for the 150- and the 200-gram springs.

Pre-transplant gingival hyperplasia predicts severe cyclosporin-induced gingival overgrowth in renal transplant patients.

The relationship between the pre-transplant periodontal status and the development of post-transplant gingival overgrowth was investigated in a longitudinal study. The periodontal condition of 35 patients was examined on 2 occasions while they were on the transplant waiting list and then at 4-6, 10-12, 16 and 20 weeks post-transplant. At each visit the plaque index, the bleeding index and a pocket index (CPITN) were measured. Dental impressions were taken of the pre- and post-transplant gingival condition and used to make stone models which were used to score the gingival overgrowth index (GOI). The patients divided into 3 distinct groups having severe (n=13), mild (n=16) or no post-transplant gingival overgrowth (n=6). Only 1 of the patients had taken cyclosporin prior to inclusion into the study. All the patients who developed severe overgrowth had evidence of gingival hyperplasia before the transplant. There was no difference in the serum cyclosporin levels between the three groups (chi2<2.28, p>0.319). Furthermore, there was no statistical difference for any of the periodontal indices. This study indicates that the hyperplastic gingival inflammatory response of some individuals appears to be potentiated by cyclosporin resulting in severe post-transplant overgrowth. In other patients the same reaction may allow the fibroblastic activity to occur to an extent where it produces a mild clinically apparent overgrowth.

Wear: mechanisms, manifestations and measurement. Report of a workshop.

OBJECTIVE: The purpose of this workshop was to bring together a tribologist (T.A.S.), a clinician (L.H.M) and a dental materials scientist (R.W.V) to discuss the fundamental mechanisms of wear and how these relate to the manifestations and measurement of wear in dentistry. Eighty delegates contributed to a valuable discussion led by the workshop chairman (C.H.L.). KEY POINTS: Wear is the net result of a number of fundamental processes: abrasion, adhesive effects, fatigue and corrosive effects which act in different combinations on the various classes of materials. In ceramics, sliding compression and surface corrosion greatly increase wear, whereas the ability to deform either plastically or elastically influences the wear of polymers. The filler particle distribution is a major variable influencing the wear of composites. In the mouth, wear can be considered in terms of its site, timing and mechanism. The latter may involve direct contact between surfaces or result from the action of slurries; both of which are affected by surface corrosion (erosion). Although wear can be categorized at the chairside, its precise measurement involves the use of replica models and surface contouring. Laboratory simulation is useful to study fundamental wear mechanisms; but it is not able to predict clinical wear. CONCLUSIONS: The management of clinical wear requires a proper understanding of the underlying mechanisms. This can only be achieved through close co-operation between all the disciplines which seek to understand and manage wear. The attendance of so many delegates at this workshop indicates the willingness to participate in this process.

Wear patterns in two amalgams and three posterior composites after 5 years' clinical service.

OBJECTIVES: The purpose of this research was to evaluate the wear patterns of three posterior composites (Clearfil Posterior. Occlusin and P-30) and two amalgams (New True Dentalloy, Solila Nova) after 5 years' clinical service. METHODS: Marginal wear was measured using the stepwedge technique which determines the maximal marginal wear by any one cusp together with the mean marginal value. The overall maximum depth of wear, occurring at any site on the occlusal surface, was determined using an impression technique with epoxy models. RESULTS: The mean values (+/- standard deviations) for the overall maximum wear were: New True Dentalloy, 203 +/- 98 microns; Solila Nova, 200 +/- 96 microns; Clearfil Posterior, 252 +/- 141 microns; Occlusin, 324 +/- 189 microns; P-30, 380 +/- 273 microns. These values were significantly different (ANOVA F = 2.86 P = 0.05). There was no correlation between the marginal scores and the overall maximum depth of wear (P > 0.05). There was no correlation between the marginal scores and the overall maximum depth of wear (P > 0.05). With some restorations the maximum wear occurred at the margins, marginal ridges or cavity extensions rather than sites of occlusal contact. CONCLUSIONS: After 5 years' service the overall wear of three posterior composites exceeded that of two amalgams; however, for a number of restorations the difference was not significant. Marginal wear values cannot be used to predict the overall maximal depth of wear.

Subsurface compression fatigue in seven dental composites.

OBJECTIVES: The purpose of this study was to evaluate subsurface fatigue in seven dental composites. METHODS: Cylindrical test pieces were subjected to 2000 compression cycles with a load of 120 N. The area of stained subsurface was measured, and subsequently, the specimens were examined by scanning electron microscopy. RESULTS: The greatest staining occurred in the composites with large quartz fillers, whereas there was little staining in the microfilled materials. Electron microscopy demonstrated very little evidence of cracks, suggesting that silver nitrate stained a network of crazes and microcracks in the subsurface. The pattern of staining indicated that the microcracks formed within the depth of the subsurface rather than by direct nucleation from the indenter. SIGNIFICANCE: The different patterns of subsurface damage occurring as a result of compression should be considered when studying the wear and degradation of these materials.

A comparison of the rate of space closure using a nickel-titanium spring and an elastic module: a clinical study.

A study of the efficiency of space closure after premolar extraction was undertaken, comparing a nickel-titanium closed coil spring and an elastic retraction module by using sliding mechanics along an 0.019 x 0.025-inch stainless steel arch wire in 0.022 x 0.028-inch preadjusted stainless steel brackets. The rate of space closure in 17 subjects was analyzed from study models and was found to be significantly greater and more consistent with the nickel-titanium closed coil springs than with the elastic modules, in both arches. There were no clinically observable differences in the tooth positions between the respective techniques.

Synolite as a base resin for dental composites and related biomaterials.

Synolite resin was analysed using FTIR, NMR and HPLC to determine its components and purity. The resin was found to be predominantly BIS-GMA containing traces of its two isomers. The analysis indicated that there was no unreacted methacrylic acid or other impurities.