A simple technical innovation to prevent needle stick injuries among dental professionals.

OBJECTIVE: Dental healthcare personnel face the potential danger of being exposed to infectious patients while administering local anesthesia injections during dental operations. This could lead to unintentional transfer of infectious diseases from patients to physicians. Although safety measures such as the One-hand-scoop technique and the use of safety syringes, plastic needle cap holders, and needles with safety caps are in place, there have been instances of needle stick injuries reported in clinics. This might be due to the lack of adherence to conventional safety measures or the impracticality of safety techniques and safety syringes. This article aims to demonstrate the utilization of dental tweezers, specifically London College tweezers or dental forceps, for the secure recapping of needles, eliminating the requirement for extra equipment or devices. SUBJECTS AND METHODS: After obtaining ethical approval (Approval No.: 024-01-2024) from the College of Dentistry, Dar Al Uloom University, 67 dental professionals, with consent for participation in the study, were included. They were requested to use dental tweezers/London College tweezers and dental extraction forceps such as maxillary anterior, mandibular anterior, and maxillary bayonet root forceps individually to recap the local anesthetic needles. The efficacy of these techniques was evaluated against the one-hand scoop technique for its ease, convenience, and reliability in preventing needle stick injuries. RESULTS: The evaluation of dental professionals regarding the ease of using dental tweezers to recap needles, compared to the one-hand scoop technique (p=0.592), maxillary bayonet root forceps (p=0.746), mandibular anterior forceps (p=0.380), and maxillary anterior forceps (p=0.808), did not yield statistically significant results. The assessment of the procedural simplicity of the one-hand scoop technique showed a satisfaction rate of over 40%, whereas the application of dental tweezers resulted in a satisfaction rate of 30%. However, the use of dental tweezers for needle recapping resulted in a satisfaction rate of over 50%, compared to a satisfaction rate of 30% for the one-handed scoop technique. CONCLUSIONS: There is no statistically significant difference in the assessment of the efficacy of dental tweezers and the one-hand scoop technique, bayonet root forceps, mandibular anterior forceps, maxillary anterior forceps, and dental tweezers for the needle capping technique. Therefore, dental forceps can be used instead of the one-handed scoop approach. The needle recapping procedure outlined in our study, aimed at preventing needle stick injuries, is simple to implement, and all dental specialties have convenient access to the required instruments.

Is the value of oral health related to culture and environment, or function and aesthetics?

OBJECTIVE: To examine the disutility of tooth loss. It compared how people value their teeth in two countries which are culturally similar in order to explore the effect of culture on self-perceptions of oral health. BASIC RESEARCH DESIGN: Cross sectional study. PARTICIPANTS: Participants were recruited from subjects attending two hospitals in Turkey and in Iran. INTERVENTIONS: Nineteen descriptions of mouths with varying degrees and types of tooth loss were presented to the participants. They were shown mouth models of partially edentate dentitions and the teeth missing were explained in relation to the participants own mouth. The participants were specifically asked to consider the role their teeth played in function (chewing), communication (speech) and aesthetics (looks) along with "all the other things that make your mouth important". MAIN OUTCOME MEASURES: The participants were asked to indicate on a visual analogue scale how they would value the health of their mouth if they lost the tooth/teeth described and the resultant space was left unrestored. RESULTS: Overall 152 subjects participated, 78 in Turkey and 74 in Iran with 83 being female and 69 male. Their mean age was 29.5 years (SD 9.3), 62.5% had experienced tooth loss and 37.5% had complete (or completely restored) dentitions. Although there were no differences between the two countries in the degree of utility people attached to anterior teeth, Turkish participants attached significantly more disutility than Iranians to the loss of premolar and molar teeth (p < 0.003). CONCLUSION: Country of origin had an influence on the value placed on certain parts of the dentition and this effect is independent of the number of missing teeth, gender and age. This implies that attitudes to oral health are influenced by prevalent cultural attitudes more than by function.

Comparison of utility weighted DMFT with patient-reported oral well-being.

This study investigated a method of measuring oral health, as opposed to measuring disease. The objective was to compare DMF score and whole mouth utility scores to a patient-reported outcome measure (PROM). Disutility values for lost and restored teeth were used to weight the decayed, missing and filled teeths(DMFTs) of 10 adult patients. This gave two whole mouth utility scores (WMU). These scores were then compared with a patient-reported oral health outcome measure recorded by the use of a visual analogue scale (VAS). The anchors for the VAS were 'my mouth could not be worse' and 'my mouth could not be better'. There was a positive correlation (r = 0.6457) between WMU1 and the patient-reported outcome measure (P < 0.05) and a negative correlation (r = -0.8383) between WMU1 and DMFT which was significant at the P < 0.01 level. There was a statistically significant positive correlation of r = 0.7926 between WMU2 and the patient-reported outcome measure (P < 0.01) and a negative correlation (r = -0.9393) between WMU2 and DMFT (P < 0.01). The Pearson's correlation between DMFT and the patient-reported outcome measure was -0.8757, which was significant at the 0.01 level. Patient reports of their perceived level of health correlate well with DMFT scores. Weighting DMFT scores according to the differential values assigned to missing, or missing and filled, teeth does not increase the degree of correlation between the measure and the patients' personal quantification of their oral health. Decayed, missing and filled teeth therefore seems to adequately capture the patient's sense of well-being.

Extensive review in the detection of the malignant transformation of pleomorphic adenoma.

BACKGROUND AND OBJECTIVES: There is an increasing likelihood of malignant change in pleomorphic adenoma (PA) with time. This extensive review aims to highlight the current areas of difficulty or controversy in the diagnosis of malignant transformation of pleomorphic adenoma - a subject of most interest and challenge to a pathologist. It is also the objective of this review to compare the clinical and pathological points-of-view on the diagnosis of malignant transformation of pleomorphic adenoma. METHODS: A literature search using MEDLINE, accessed through the National Library of Medicine PubMed interface, for articles relating to malignant transformation of pleomorphic salivary adenoma written in the English language. RESULTS: The updated literature indicates that carcinomas in pleomorphic adenoma may arise in an older age group than benign lesions and are usually larger and longer standing lesions. The use of molecular changes to study malignant transformation of pleomorphic adenoma, unfortunately, have no specific expression on the tumor suppressor genes to detect the malignant transformation of pleomorphic adenoma from pathological point view. CONCLUSION: The use of combined clinical evidence and pathological evidence are very important in the detection of the malignant transformation of pleomorphic adenoma. KEYWORDS: pleomorphic adenoma, malignant transformation of pleomorphic adenoma.

Designing cobalt chromium removable partial dentures for patients with shortened dental arches: a pilot survey.

The aim of this survey was to investigate the quality of prescription for the fabrication of cobalt chromium removable partial dentures (RPDs) that are used to extend the shortened dental arches (SDAs). A survey of four commercial dental laboratories located in northern England was conducted. The target of this survey was cobalt chromium RPDs that were requested to restore SDAs comprising the anterior teeth and 2-4 premolars. Dentists' prescriptions were scrutinised, and a special data collection form was completed accordingly. A total of 94 dentists' prescriptions and associated SDA casts were examined. Almost all the requested cobalt chromium RPDs were clasp-retained RPDs (97%). Scrutinising the 91 prescriptions for clasp-retained cobalt chromium RPDs showed that dentists' prescriptions did not have any instructions about the design of the partial denture in a considerable proportion of the cases (32%). Teeth to be clasped were identified clearly in 45% of the prescriptions. A majority of the dentists (64%) failed to provide any instructions about the design of the rests to be placed on the most posterior premolar abutment teeth. A considerable proportion of the dentists delegated the task of selecting the type of the major connector to the dental technician (41%). Only 21 (23%) of the examined casts had clearly defined rest seat preparation. The outcome of this pilot survey shows inadequate quality of prescription in designing RPDs for patients with SDAs. This finding has an ethical and clinical bearing and does not fit with current legal guidelines relevant to designing RPDs.

Tooth loss--an assessment of dental health state utility values.

OBJECTIVE: The study described aimed to measure the value placed on oral health, by measuring the utility of mouths in which teeth had been lost. METHODS: A total of 102 subjects who had experienced tooth loss were interviewed and presented with 19 different scenarios of mouths with missing teeth. Each written description was accompanied by a verbal explanation and digital pictures of mouth models. Participants were asked to indicate on a standardized visual analogue scale how they would value the health of their mouth if they had lost the tooth/teeth described and the resulting space was left unrestored. RESULTS: With a utility value of 0.0 representing the worst possible health state for a mouth and 1.0 representing the best, the mouth with the upper central incisor missing attracted the lowest utility value (utility = 0.16), the one with a missing upper second molar and the missing lower second molar attracted the highest utility values (utility = 0.48, 0.47, respectively). With respect to shortened dental arch (SDA) scenarios, a mouth with a SDA with only the second molar teeth in all quadrants missing attracted the highest utility value (utility = 0.45). A mouth with an extreme SDA with both missing molar and premolar teeth attracted the lowest utility value (utility = 0.06). Both age and gender have a significant influence on how the dentition is valued. CONCLUSION: It is feasible and possible to derive measurements of the impact of various degrees of tooth loss on individuals. Further studies are required to examine whether past tooth loss or oral health status affects how tooth loss is viewed.

Dental health state utility values associated with tooth loss in two contrasting cultures.

The study aimed to assess the value placed on oral health states by measuring the utility of mouths in which teeth had been lost and to explore variations in utility values within and between two contrasting cultures, UK and Iran. One hundred and fifty eight patients, 84 from UK and 74 from Iran, were recruited from clinics at University-based faculties of dentistry. All had experienced tooth loss and had restored or unrestored dental spaces. They were presented with 19 different scenarios of mouths with missing teeth. Fourteen involved the loss of one tooth and five involved shortened dental arches (SDAs) with varying numbers of missing posterior teeth. Each written description was accompanied by a verbal explanation and digital pictures of mouth models. Participants were asked to indicate on a standardized Visual Analogue Scale how they would value the health of their mouth if they had lost the tooth/teeth described and the resulting space was left unrestored. With a utility value of 0.0 representing the worst possible health state for a mouth and 1.0 representing the best, the mouth with the upper central incisor missing attracted the lowest utility value in both samples (UK = 0.16; Iran = 0.06), while the one with a missing upper second molar the highest utility values (0.42, 0.39 respectively). In both countries the utility value increased as the tooth in the scenario moved from the anterior towards the posterior aspect of the mouth. There were significant differences in utility values between UK and Iranian samples for four scenarios all involving the loss of anterior teeth. These differences remained after controlling for gender, age and the state of the dentition. With respect to the SDA scenarios, a mouth with a SDA with only the second molar teeth missing in all quadrants attracted the highest utility values, while a mouth with an extreme SDA with both missing molar and premolar teeth in all quadrants attracted the lowest utility values. The study provided further evidence of the validity of the scaling approach to utility measurement in mouths with missing teeth. Some cross-cultural variations in values were observed but these should be viewed with due caution because the magnitude of the differences was small.