150 years of dental education and research - University of Birmingham School of Dentistry.

This paper discusses the historical development of dental education and research over the last 150 years from a Birmingham School of Dentistry perspective. The School opened its doors to students in 1858 and has seen many changes and developments in both education and research. Looking back throughout the history, one of our greatest abilities as dental professionals is to be adaptable and the future will bring plenty of opportunity for us to demonstrate this. We have seen how resilient dentistry has been over the COVID-19 pandemic, both in terms of education and research; the next 150 years will be a very exciting time to work in the field.

Discovery, validation, and diagnostic ability of multiple protein-based biomarkers in saliva and gingival crevicular fluid to distinguish between health and periodontal diseases.

AIM: To discover and validate differential protein biomarker expression in saliva and gingival crevicular fluid (GCF) to discriminate objectively between periodontal health and plaque-induced periodontal disease states. MATERIALS AND METHODS: One-hundred and ninety participants were recruited from two centres (Birmingham and Newcastle upon Tyne, UK) comprising healthy, gingivitis, periodontitis, and edentulous donors. Samples from the Birmingham cohort were analysed by quantitative mass spectrometry proteomics for biomarker discovery. Shortlisted candidate proteins were then verified by enzyme-linked immunosorbent assay in both cohorts. Leave-one-out cross validation logistic regression analysis was used to identify the best performing biomarker panels. RESULTS: Ninety-five proteins were identified in both GCF and saliva samples, and 15 candidate proteins were selected based upon differences discovered between the donor groups. The best performing panels to distinguish between: health or gingivitis and periodontitis contained matrix metalloproteinase-9 (MMP9), S100A8, alpha-1-acid glycoprotein (A1AGP), pyruvate kinase, and age (area under the curve [AUC] 0.970); health and gingivitis contained MMP9, S100A8, A1AGP, and pyruvate kinase, but not age (AUC 0.768); and mild to moderate and advanced periodontitis contained MMP9, S100A8, A1AGP, pyruvate kinase, and age (AUC 0.789). CONCLUSIONS: Biomarker panels containing four proteins with and without age as a further parameter can distinguish between periodontal health and disease states.

Using quizzes to provide an effective and more enjoyable dental education: A pilot study.

INTRODUCTION: Increasingly, dental education is using digital strategies to deliver teaching; however, not all of these learning materials are engaging and effective. AIM: To evaluate the perception and knowledge retention of undergraduate dental students after using two different digital learning tools: quizzes and PDF. METHODS: Thirty-three students from a Dental School in the United Kingdom took part in the research. They received learning material derived from the Prosthodontic (Kennedy classification) or Paediatric dentistry content (Tooth classification). The same content was delivered in two different formats: quiz game (n = 17) and PDF file (n = 16). The PDF file had ten images and their classifications, whilst the quiz had the same images with a question about the classification, along with alternatives (single best answer). RESULTS: All students gave similar performances on the knowledge assessment; however, their perception about the learning material differed. Students using quizzes (88%) agreed that they were fun and an interesting way of learning, while only 37.5% had this opinion about PDF material (p = .002). When using quizzes, learners were more motivated and confident. They would frequently recommend quizzes to other colleagues; however, the use of PDF was not suggested as frequently (p = .039). As a learning strategy, 100% of the students using quizzes wanted more of the same to study other dental subjects. This was not the case with the PDF format (p = .005). CONCLUSION: Despite quizzes and PDF files resulting in a similar understanding of dental subjects, learners prefer quizzes to supplement their studies. Educators should consider using this interactive digital tool to engage students, instead of PDF files.

Galactin-3 and soluble ST2 as complementary tools to cardiac MRI for sudden cardiac death risk stratification in heart failure: A review.

Heart failure (HF) is recognized as one of the leading causes of morbidity and mortality worldwide. Every year about 500,000 new cases of HF are diagnosed in the United States. The predominant etiology of death in HF patients include sudden cardiac death (SCD) and pump failure. Prediction of mode of death may help in devising management decisions. In patients with HF, the presence of myocardial fibrosis has been a known risk factor for SCD and thus it could be used as a criterion in risk stratification for SCD. However, the underlying pathophysiology of SCD is uncertain and controversial, which makes it necessary to develop newer tools to enhance SCD risk stratification. The newer tools should be innovative enough either to complement or to replace the currently available tools. In this scoping review, we highlighted the utilization of novel biomarkers galectin-3 (gal-3) and soluble ST2 (sST2) and discussed that how they might complement currently available tools such as, cardiac MRI (CMR) for SCD risk stratification in HF patients.

ADEA-ADEE Shaping the Future of Dental Education III: Engaging with global networking to enable global oral health.

Global networking has been identified as an important method of enhancing health care education and services in the field of dentistry.1 The ability to share expertise, resources, knowledge, and experience to benefit all is highly desired among students, educators, health care professionals, and communities globally. Both our student and patient populations are dynamic societies that are becoming increasingly complex and facing growing needs and expectations, which is a constant challenge for educators and health care professionals to satisfy.2 The key question, stemming from the Global Networking (GN) workshop of the 2017 ADEE-ADEA Shaping the Future of Dental Education II meeting, was identified as, "How can dental educators around the world network to share ideas, experience, expertise, and resources to improve our curricula and teaching and learning environments for our educators, students, and communities that they serve?" The action plan devised by the GN workshop from the 2017meeting indicated two key steps in these early stages of setting up a global network: 1) "…grassroots participation for input and consumption of meaningful and needed content," and 2) "…advisors/consultants for organizational top-down guidance to define and maintain the global networking philosophy and platform…".1 The GN workshop of 2019 SFDE meeting aimed to deliver guidance and discussion with those experienced in engaging local communities from both a grassroots and an organizational approach.

Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture.

Management of benign gastrointestinal (GI) strictures refractory to primary (balloon and savary dilation) and secondary (steroid injection, fully covered self-expanding metal stent, incision therapy) treatment modalities remains a challenge. Lumen-apposing metal stents (LAMSs), originally designed for the management of pancreatic fluid collections, are an attractive option for GI stricture because of their anti-migratory property, attributable to their saddle-shaped design. In this article, we reviewed 70 patients from 12 original studies who received LAMS for refractory (68/70) or treatment-naïve (2/70) benign GI stricture. The technical and clinical success rates were 98.6% (69/70) and 79.7% (55/69), respectively. Endoscopic placement, with or without fluoroscopic guidance, was generally successful, with only a minority requiring endoscopic ultrasound (EUS) guidance where the lumen was completely obscured. The majority of the strictures were short (≤1 cm), but comparable technical and clinical success was noted in isolated cases with long strictures, where 2 overlapping LAMSs were placed. For the overall population, a failure rate of 21.5% (14/69) was noted and was attributed to either lack of follow up, or to persistent or de novo symptoms requiring stent removal/exchange or surgical referral. One perforation (1.4%), five stent migration events (7.1%), two bleeding events (2.9%) and two de novo strictures proximal to the LAMS (2.9%) were reported for the entire study cohort. No mortality was attributable to LAMS placement. Although experience is still evolving, LAMS placement guided by esophagogastroduodenoscopy or EUS is a technically feasible and safe procedure with good clinical outcomes for benign refractory GI strictures.

Endoscopic Ultrasound Guided Choledocho-Enterostomy by Using Lumen Apposing Metal Stent in Patients with Failed Endoscopic Retrograde Cholangiopancreatography: A Literature Review.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the management of malignant jaundice to provide symptomatic relief and/or to allow chemotherapy. Difficult biliary cannulation or the presence of concomitant duodenal obstruction may lead to its failure. METHOD: An extensive English literature search was done via PubMed and Google Scholar to identify 13 peer-reviewed original articles. RESULTS: Of 92 patients, 98.9% (91/92) successfully underwent EUS-guided biliary drainage by placement of a lumen-apposing metal stent (LAMS) across extrahepatic biliary tree and small bowel. Although technically challenging, a similar technical success was noted for patients with limited dilation of extrahepatic biliary tree (less than 1 cm) and altered gastrointestinal anatomy (Roux-en-Y, Whipple, or Billroth II). Of 91 patients, 98.9% (90/91) had clinical success. Procedure complications included perforation (2/92; 2.2%) and bleeding (1/92; 1.1%). Stent complications included obstruction (7/91; 7.7%), and migration (1/91; 1.1%) with all responding to endoscopic debridement of food or tumor, placement of plastic pigtail stent through the LAMS, or replacement with a new stent. No procedure-related mortality was noted. CONCLUSION: In the hands of an expert, EUS-guided biliary drainage with the use of LAMS is an efficacious and safe option for patients with distal malignant biliary stricture, not amenable to ERCP.

Efficacy and Safety of Flexible Endoscopic Management of Zenker's Diverticulum.

Zenker's diverticulum (ZD), a pulsion diverticulum of hypopharynx is a rare but treatable cause of morbidity in geriatric population. Traditionally a surgical disease but due to its associated high morbidity, flexible endoscopy has become a lucrative option. We reviewed 997 patients from 23 original studies who underwent flexible endoscopic diverticulotomy (FED) of ZD. Composite technical and clinical success rate for the study cohort was 99.4% and 87.9%, respectively. Composite failure rate was 10.0% but close to half of them (45.3%) had success with repeat endoscopic intervention. Composite rate for symptom recurrence after long-term follow-up was 13.6% but more than half (61.8%) had success with repeat endoscopic intervention. Bleeding (6.6%) and perforation (5.3%) were 2 most common complications of FED. All bleeding events were successfully managed with observation or endoscopic therapy. Majority of perforation events (4.4%) were successfully managed with conservative care and only 0.9% required invasive management. No mortality was reported. Efficacy and safety of FED of ZD remained same irrespective of diverticulum size or prior surgical/endoscopic treatment. FED with diverticuloscope (FEDD) and FED with cap (FEDC) had comparable technical success rate (99.6% vs. 100.0%) but FEDD had higher clinical success rate compared with FEDC (86.8% vs. 75.4%). FEDD had twice the risk of symptom recurrence than FEDC (16.5% vs. 9.5%). FEDD had a comparable bleeding risk to FEDC (3.3% vs. 4.0%) but a much lower perforation rate (2.3% vs. 10.3%). Upper esophageal sphincterotomy and adequate length of septotomy are the cornerstones of FED. FED can be considered a safe and efficacious treatment modality for patients with ZD.

Ultrasound field characterization and bioeffects in multiwell culture plates.

BACKGROUND: Ultrasound with frequencies in the kilohertz range has been demonstrated to promote biological effects and has been suggested as a non-invasive tool for tissue healing and repair. However, many challenges exist to characterize and develop kilohertz ultrasound for therapy. In particular there is a limited evidence-based guidance and standard procedure in the literature concerning the methodology of exposing biological cells to ultrasound in vitro. METHODS: This study characterized a 45-kHz low-frequency ultrasound at three different preset intensity levels (10, 25, and 75 mW/cm(2)) and compared this with the thermal and biological effects seen in a 6-well culture setup using murine odontoblast-like cells (MDPC-23). Ultrasound was produced from a commercially available ultrasound-therapy system, and measurements were recorded using a needle hydrophone in a water tank. The transducer was displaced horizontally and vertically from the hydrophone to plot the lateral spread of ultrasound energy. Calculations were performed using Fourier transform and average intensity plotted against distance from the transducer. During ultrasound treatment, cell cultures were directly exposed to ultrasound by submerging the ultrasound transducer into the culture media. Four groups of cell culture samples were treated with ultrasound. Three with ultrasound at an intensity level of 10, 25, and 75 mW/cm(2), respectively, and the final group underwent a sham treatment with no ultrasound. Cell proliferation and viability were analyzed from each group 8 days after three ultrasound treatments, each separated by 48 h. RESULTS: The ultrasonic output demonstrated considerable lateral spread of the ultrasound field from the exposed well toward the adjacent culture wells in the multiwell culture plate; this correlated well with the dose-dependent increase in the number of cultured cells where significant biological effects were also seen in adjacent untreated wells. Significant thermal variations were not detected in adjacent untreated wells. CONCLUSIONS: This study highlights the pitfalls of using multiwell plates when investigating the biological effect of kilohertz low-frequency ultrasound on adherent cell cultures.

Implant-supported mandibular denture: planning to delivery--a case report.

UNLABELLED: Restoring the edentulous mandible with a removable prosthesis can be a challenging prospect for both the dentist and patient during and after treatment. Poor retention and support are the major problems reported with a mandibular complete denture and these can be significantly improved with the use of implants and retentive attachments. Utilizing implants requires careful planning from both the surgical and restorative aspects to ensure that the intended treatment aim and outcome is achieved. CLINICAL RELEVANCE: This case highlights the importance of both restorative and surgical considerations when planning the rehabilitation of the mandible with dental implants.

Biophysical characterization of low-frequency ultrasound interaction with dental pulp stem cells.

BACKGROUND: Low-intensity ultrasound is considered an effective non-invasive therapy to stimulate hard tissue repair, in particular to accelerate delayed non-union bone fracture healing. More recently, ultrasound has been proposed as a therapeutic tool to repair and regenerate dental tissues. Our recent work suggested that low-frequency kilohertz-range ultrasound is able to interact with dental pulp cells which could have potential to stimulate dentine reparative processes and hence promote the viability and longevity of teeth. METHODS: In this study, the biophysical characteristics of low-frequency ultrasound transmission through teeth towards the dental pulp were explored. We conducted cell culture studies using an odontoblast-like/dental pulp cell line, MDPC-23. Half of the samples underwent ultrasound exposure while the other half underwent 'sham treatment' where the transducer was submerged into the medium but no ultrasound was generated. Ultrasound was applied directly to the cell cultures using a therapeutic ultrasound device at a frequency of 45 kHz with intensity settings of 10, 25 and 75 mW/cm(2) for 5 min. Following ultrasound treatment, the odontoblast-like cells were detached from the culture using a 0.25% Trypsin/EDTA solution, and viable cell numbers were counted. Two-dimensional tooth models based on µ-CT 2D images of the teeth were analyzed using COMSOL as the finite element analysis platform. This was used to confirm experimental results and to demonstrate the potential theory that with the correct combination of frequency and intensity, a tooth can be repaired using small doses of ultrasound. Frequencies in the 30 kHz-1 MHz range were analyzed. For each frequency, pressure/intensity plots provided information on how the intensity changes at each point throughout the propagation path. Spatial peak temporal average (SPTA) intensity was calculated and related to existing optimal spatial average temporal average (SATA) intensity deemed effective for cell proliferation during tooth repair. RESULTS: The results demonstrate that odontoblast MDPC-23 cell numbers were significantly increased following three consecutive ultrasound treatments over a 7-day culture period as compared with sham controls underscoring the anabolic effects of ultrasound on these cells. Data show a distinct increase in cell number compared to the sham data after ultrasound treatment for intensities of 10 and 25 mW/cm(2) (p < 0.05 and p < 0.01, respectively). Using finite element analysis, we demonstrated that ultrasound does indeed propagate through the mineralized layers of the teeth and into the pulp chamber where it forms a 'therapeutic' force field to interact with the living dental pulp cells. This allowed us to observe the pressure/intensity of the wave as it propagates throughout the tooth. A selection of time-dependent snapshots of the pressure/intensity reveal that the lower frequency waves propagate to the pulp and remain within the chamber for a while, which is ideal for cell excitation. Input frequencies and pressures of 30 kHz (70 Pa) and 45 kHz (31 kPa), respectively, with an average SPTA of up to 120 mW/cm(2) in the pulp seem to be optimal and agree with the SATA intensities reported experimentally. CONCLUSIONS: Our data suggest that ultrasound can be harnessed to propagate to the dental pulp region where it can interact with the living cells to promote dentine repair. Further research is required to analyze the precise physical and biological interactions of low-frequency ultrasound with the dental pulp to develop a novel non-invasive tool for dental tissue regeneration.

Long and short term management of implant-supported mandibular overdentures.

UNLABELLED: Common problems with the long term clinical use of implant-supported mandibular overdentures (ISMDs) include fractures of dentures, bars and clips, and reactivation of clips. Many general dental practitioners (GDPs) are reticent to be involved in the maintenance of ISMDs, especially if they have not had any further training or are unfamiliar with implant components and systems. This article highlights the need for the training of GDPs in maintenance and management of ISMDs as an increasing number of edentulous patients are being provided with ISMDs, resulting in an increasing need for the maintenance of the prosthesis in the primary care setting at a possible cost to the patient. CLINICAL RELEVANCE: Implant-supported overdentures are becoming a common treatment option for edentulous patients, however, they are not without their clinical challenges, many of which can be easily rectified in a primary care environment, such as general practice.