Role models in academic dentistry.
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Career Choice↗
Biomedical subjects
A D Walmsley
Publications and source records attributed to A D Walmsley.
Selective dental history.
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History, 19th Century↗
A review of prosthodontic management of fibrous ridges.
'Fibrous' or 'flabby' alveolar ridges pose significant problems for the provision of stable and retentive dental prostheses for affected patients. In particular, problems arise during the act of impression taking, when forces cause the mobile denture bearing tissues to become distorted. The purpose of this paper is to review the impression techniques that can be used to optimise the treatment of edentulous patients with 'flabby' alveolar ridges.
Dental Impression Technique↗
Manual versus powered toothbrushing for oral health.
BACKGROUND: Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. OBJECTIVES: To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register (to 17/06/2004) and Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to week 2 June 2004); EMBASE (January 1980 to week 2 2004) and CINAHL (January 1982 to week 2 June 2004). Manufacturers were contacted for additional data. SELECTION CRITERIA: Trials were selected for the following criteria: design-random allocation of participants; participants - general public with uncompromised manual dexterity; intervention - unsupervised manual and powered toothbrushing for at least 4 weeks. Primary outcomes were the change in plaque and gingivitis over that period. DATA COLLECTION AND ANALYSIS: Six authors independently extracted information. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. For discussion purposes SMD was translated into percentage change. MAIN RESULTS: Forty-two trials, involving 3855 participants, provided data. Brushes with a rotation oscillation action removed plaque and reduced gingivitis more effectively than manual brushes in the short term and reduced gingivitis scores in studies over 3 months. For plaque at 1 to 3 months the SMD was -0.43 (95% CI: -0.72 to -0.14), for gingivitis SMD -0.62 (95% CI: -0.90 to -0.34) representing an 11% difference on the Quigley Hein plaque index and a 6% reduction on the Loe and Silness gingival index. At over 3 months the SMD for plaque was -1.29 (95% CI: -2.67 to 0.08) and for gingivitis was -0.51 (-0.76 to -0.25) representing a 17% reduction on the Ainamo Bay bleeding on probing index. There was heterogeneity between the trials for the short-term follow up. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered designs were as consistently superior to manual toothbrushes.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and temporary. AUTHORS' CONCLUSIONS: Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.
Dental Devices, Home Care↗
The neutral zone impression revisited.
The neutral zone technique is an alternative approach for the construction of lower complete dentures. It is most effective for dentures where there is a highly atrophic ridge and a history of denture instability. The technique aims to construct a denture that is shaped by muscle function and is in harmony with the surrounding oral structures. The technique is by no means new but is a valuable one. This paper aims to provide clinicians with the knowledge to use the technique - a list of competencies is included.
Alveolar Bone Loss↗
A study to determine whether cavitation occurs around dental ultrasonic scaling instruments.
The aim of this investigation was to determine if cavitation occurred around dental ultrasonic scalers and to estimate the amount of cavitation occurring. Three styles of tip (3 x TFI-10, 3 x TFI-3, 3 x TFI-1) were used, in conjunction with a Cavitron SPS ultrasonic generator (Dentsply, USA), to insonate terephthalic acid solution. The hydroxyl radical, [*OH], concentration, produced due to cavitation from the scaler tips, was monitored by fluorescence spectroscopy. Cavitational activity was enhanced at higher power settings and at longer operating times. The tip dimensions and geometry as well as the generator power setting are both important factors that affect the production of cavitation.
Dental Scaling↗
Profile and competences for the European dentist.
This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Cardiff in September 2004. A task-force drafted the document, which was then sent to all European Dental Schools. Reactions received were used to amend the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed in 5 years time. This paper will be disseminated to ministries of health, national dental associations and dental specialty associations or societies in Europe and these organisations will be asked to offer their comments. This information will be used in the reviewing process to be started in 2007. It is hoped that the availability of this document will assist dental schools in Europe to further harmonize and improve the quality of their curricula.
Dentistry↗
An implementation strategy for introducing an OSCE into a dental school.
INTRODUCTION: The Objective Structured Clinical Examination (OSCE) uses a series of test-stations to test clinical competencies. The introduction of an OSCE in a dental school is always a new experience for both staff and students and may result in a change in assessment methods. As resistance could develop when changes are introduced into an organisation, the use of a strategy for the implementation of such change will help to diminish opposition and may therefore result in the co-operation of staff and their departments. The objective of this study was to investigate the effectiveness of an implementation strategy by measuring attitudes of both staff and students towards the OSCE as a new form of clinical assessment in a dental school (ACTA). MATERIALS AND METHODS: 'Stepwise' behaviour change (with information, participation and commitment as tools) was used as a strategy to minimise protective behaviour to the introduction of an OSCE. After lectures on assessment, 59 staff members participated in a mini-OSCE with eight test-stations, playing both the role of a student and observer. A questionnaire, designed to test attitudes and commitment towards the new OSCE was completed after the examination. Six months later, 22 staff of all departments had developed and run a pilot OSCE for 44 students. A similar questionnaire was answered by staff and students. A year later, another OSCE for all 103 third year students was designed, organised and evaluated with full co-operation of the clinical teaching staff. RESULTS: Staff total attitude grew positively (P = 0.001). Student's total attitude was lower than staff (P < 0.001) The results of the survey after the mini-staff-OSCE and pilot and final OSCE were favourable in terms of the acceptance of use of an OSCE for the assessment of clinical competences. CONCLUSION: The implementation strategy appears to have been successful. The objective of gaining the co-operation of staff and departments and avoiding resistance to change was achieved.
Attitude↗
A new insight into the oscillation characteristics of endosonic files used in dentistry.
The aim of this study was to assess the oscillation characteristics of unconstrained endosonic files using a scanning laser vibrometer (SLV). Factors investigated included file vibration frequency and node/antinode location as well as the variation in file displacement amplitude due to increasing generator power setting. A 30 kHz Mini Piezon generator (Electro-Medical Systems, Switzerland) was used in conjunction with a #15 and #35 K-file. Each file was fixed in position with the long axis of the file perpendicular to the SLV camera head. The laser from the SLV was scanned over the length of the oscillating file for generator power settings 1 to 5 (minimum to half power). Measurements were repeated ten times. The fundamental vibration frequency for both files was 27.50 kHz. Scans of each file showed the positions of nodes/anti-nodes along the file length. The #15 file demonstrated no significant variation in its mean maximum displacement amplitude with increasing generator power, except at power setting 5, where a decrease in displacement amplitude was observed. The #35 file showed a general increase in mean maximum displacement amplitude with increasing power setting, except at power setting 4 where a 65% decrease in displacement amplitude occurred. In conclusion, scanning laser vibrometry is an effective method for assessing endosonic file vibration characteristics. The SLV was able to demonstrate that (unloaded) file vibration displacement amplitude does not increase linearly with increasing generator power. Further work is being performed on a greater variety of files and generators. Vibration characteristics of files under various loads and varying degrees of constraint should also be investigated.
Dentistry↗
The attitudes of undergraduate students and staff to the use of electronic learning.
BACKGROUND: Computer-aided learning (CAL) offers advantages over traditional methods of learning as it allows students to work in their own time and pace. The School of Dentistry at the University of Birmingham has created an electronic learning website, named the Ecourse. This is designed to be a web-based supplement to the dental undergraduate curriculum. AIM: The aim of this study was to determine the attitudes of third year dental students and members of staff about the Ecourse website. METHOD: A questionnaire was produced and piloted before being distributed to all 65 third year dental students to obtain their opinions about the Ecourse website. The views of Ecourse were sought from four members of staff by performing qualitative, semi-structured interviews. RESULTS: Lecture handouts and textbooks were reported as the sources used most often, by 96% of students. Eighty-six per cent of students are accessing the Ecourse mainly at the School of Dentistry, but 53% are also accessing it at home. Students liked the multiple-choice questions, downloading extra notes and looking at pictures and animation to explain clinical procedures. The majority of the students (79%) want the Ecourse to be used as a supplement to the undergraduate programme and 7% wanted it to replace formal lectures. Staff recognised the benefits of the Ecourse but were concerned about plagiarism, the effect on lecture attendance and the lack of feedback from students on existing CAL material. CONCLUSION: Students consider the Ecourse as a positive method of supplementing traditional methods of learning in the dental undergraduate programme. However in contrast teaching staff expressed negative views on the use of e-learning.
Attitude↗
The effectiveness of manual versus powered toothbrushes for dental health: a systematic review.
OBJECTIVES: To compare manual and powered toothbrushes in everyday use, principally in relation to plaque removal and gingival health. Stain, calculus removal, dependability, adverse effects and cost were also considered. METHOD: A systematic review was undertaken in collaboration with the Cochrane Oral Health Group. Five electronic databases were searched to identify randomised controlled trials comparing powered and manual toothbrushes. Trials of less than 28 days duration, or where toothbrushing was supervised, were excluded. Assessment of relevance, data extraction and validity assessment were all undertaken independently and in duplicate by two reviewers. Included studies were grouped according to the mode of action of the powered toothbrush. The primary outcomes were plaque and gingival health with data defined as either short-term (1-3 months) or long-term (greater than 3 months) duration were analysed. Powered brushes were categorised into six groups depending on mode of action. Numerical data extracted were checked by a third reviewer for accuracy and entered into RevMan (version 4.1). RESULTS: The initial search identified 354 studies. Two hundred and fifteen full articles were obtained of which 29 trials fulfilled the inclusion criteria with results, which could be entered in the meta-analysis. Twenty-six trials (1786 participants) reported short-term and 10 trials (798 participants) long-term plaque scores. Twenty-nine trials (2236 participants) reported short-term and 10 trials (798 participants) long-term gingivitis scores. Powered brushes reduced plaque and gingivitis at least as effectively as manual brushing. Rotation oscillation powered brushes statistically significantly reduced plaque and gingivitis in both the short and long-term. For plaque at one to 3 months the standardised mean difference was -0.44 (95% CI: -0.66 to -0.21), for gingivitis SMD -0.45 (95% CI: -0.76, -0.15). These represented an 11% reduction on the Quigley Hein Plaque index and a 6% reduction on the Löe and Silness gingival index. At over 3 months the effects were SMD for plaque -1.15 (95% CI: -2.02, -0.29) and SMD for gingivitis -0.51 (95% CI: -0.76, -0.25). These represented a 7% reduction on the Quigley Hein Plaque Index and a 17% reduction on the Ainamo Bay Bleeding on Probing Gingival Index. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered brush designs were consistently superior to manual toothbrushes. In these trials, data on cost, reliability and side effects were inconsistently reported. CONCLUSION: In general there was no evidence of a statistically significant difference between powered and manual brushes. However, rotation oscillation powered brushes significantly reduce plaque and gingivitis in both the short and long-term. The clinical significance of this reduction is not known. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.
Dental Devices, Home Care↗
Does cavitation occur around powered toothbrushes?
AIMS/OBJECTIVES: The aim of this investigation was to determine if cavitational activity occurred around powered toothbrushes using a chemical dosimeter system based on terephthalic acid (TA). MATERIAL AND METHODS: Five powered toothbrushes were used in this investigation: Braun Plaque Remover D8, Braun Oral-B 3D, Philips Jordan Sensiflex HX2520, Sonicare PS-1 and Sonicare Elite HX 7351/02. Each brush head was inserted into a conical flask containing 50 cm3 of aqueous TA solution. Brushes were operated for 10 and 20 min and a cuvette of the solution was placed in a fluorescence spectrometer (Perkin Elmer 3000). The fluorescence emitted at wavelength 425 nm, which is proportional to *OH radical concentration, was monitored. RESULTS: Any cavitational activity that may have been produced by the powered toothbrushes was below the limit of detection of the system (<10(-8) M) for the timescales investigated. CONCLUSIONS: This work has demonstrated that cavitational activity does not occur around powered toothbrushes. Operating the toothbrushes for periods up to 20 min resulted in no cavitational activity being detected.
Equipment Design↗
Use of dental photography by general dental practitioners in Great Britain.
This study assesses, by means of a postal questionnaire, the numbers of general dental practitioners who use clinical photography, and the uses to which this is applied. The questionnaire was distributed to 1000 randomly selected GDPs in Great Britain. A response rate of 76% was achieved. Of the respondents, 36% used clinical photography, with 65% of those using an intra-oral 35 mm camera, 18% a digital camera and 12% an intra-oral digital video camera. Principal uses of clinical photography were patient instruction/motivation (72%), medico-legal reasons (68%), treatment planning (63%), and liaison with laboratory (43%).
Communication↗
Transfer technology in dentistry.
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Dental Research↗
Manual versus powered toothbrushing for oral health.
BACKGROUND: Specific oral bacteria, generically known as "dental plaque" are the primary cause of gingivitis (gum disease) and caries. The removal of dental plaque is thought to play a key role in the maintenance of oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. OBJECTIVES: To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (to 22/8/02); Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to week 5 2002); EMBASE (January 1980 to week 3 July 2002) and CINAHL (January 1982 to June 2002). Manufacturers of powered toothbrushes were contacted for additional published and unpublished trials. SELECTION CRITERIA: Trials were selected if they met the following criteria: design-random allocation of participants; participants-general public with uncompromised manual dexterity; intervention- supervised manual and powered toothbrushing for at least four weeks; primary outcomes-the change in plaque and gingivitis over that period. DATA COLLECTION AND ANALYSIS: Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis were expressed as standardised values for each study. The effect measure for each meta-analysis was the standardised mean difference (SMD) with the appropriate 95% confidence intervals (CI) using random effect models. Potential sources of heterogeneity were examined, along with sensitivity analyses for the items assessed for quality and publication bias. MAIN RESULTS: Twenty-nine trials, involving 2,547 participants, provided data for the meta-analysis. Brushes that worked with a rotation oscillation action removed more plaque and reduced gingivitis more effectively than manual brushes in the short and long term. For plaque at one to three months the SMD was -0.44 (95% CI: -0.66 to -0.21), for gingivitis SMD -0.44 (95% CI: -0.72, -0.15). These represented an 11% reduction on the Quigley Hein plaque index and a 6% reduction on the Löe and Silness gingival index. At over three months the effects were SMD for plaque -1.15 (95% CI: -2.02,-0.29) and SMD for gingivitis -0.51 (95% CI: -0.76, -0.25). These represented a 7% reduction on the Quigley Hein Plaque Index and a 17% reduction on the Ainamo Bay Bleeding on Probing Gingival Index. The heterogeneity found in these meta-analyses for short term trials was caused by one trial that had exceptionally low standard deviations. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered brush designs were consistently superior to manual toothbrushes. In these trials, data on cost, reliability and side effects were inconsistently reported. Those side effects that were reported on in the trials were localised and temporary. REVIEWER'S CONCLUSIONS: Powered toothbrushes with a rotation oscillation action achieve a modest reduction in plaque and gingivitis compared to manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.
Dental Devices, Home Care↗
Displacement amplitude of ultrasonic scaler inserts.
OBJECTIVES: Scanning laser vibrometry is a noninvasive method of measuring the velocity, displacement amplitude and oscillation frequency of vibrating objects. The purpose of this study was to assess, using a scanning laser vibrometer (SLV), the performance of different designs of commercially available ultrasonic scaler generators by measuring the oscillatory characteristics of various scaler tips. METHODS: Four ultrasonic generators were tested (Cavitron SPS and Cavitron Select (Dentsply, York, PA, USA) and Piezon Master 400 and Mini Piezon (Electro-Medical Systems, Switzerland)) with various designs of scaler tip. The tips were positioned with their anterior surface perpendicular to the direction of the laser. A graduated scale, placed over the manufacturer's power dial, enabled incremental power setting selection. For each power setting, the laser beam from the SLV was scanned over the surface of the oscillating tip. RESULTS: The ranges of longitudinal displacement amplitudes (in micrometres) were as follows: Mini Piezon (P-tip): 12.90+/-1.44 to 44.03+/-7.80; Piezon Master 400 (P-tip): 16.02+/-2.66 to 35.85+/-5.29; Cavitron SPS (TFI-10 tip): 7.81+/-0.51 to 29.70+/-1.12; Cavitron Select (TFI-10 tip): 13.13+/-1.44 to 33.77+/-4.27; Cavitron SPS (TFI-3 tip): 5.50+/-0.46 to 31.35+/-3.62. CONCLUSIONS: This study shows that there are differences between commercially available generators and that tip movement varies between tips of the same style as well as between the generator and tip design. Users of ultrasonic scalers should be made aware of this inherent variability that may influence clinical procedures.
Dental High-Speed Technique↗
Ultrasonic dental scaler: associated hazards.
BACKGROUND: The ultrasonic dental scaler is a valuable tool in the prevention of periodontal disease; however, this equipment has a number of hazards with which it is associated. These include heating of the tooth during scaling, vibrational hazards causing cell disruption, possible platelet damage by cavitation, associated electromagnetic fields that can interrupt pacemakers, auditory damage to patient and clinician and the release of aerosols containing dangerous bacteria. OBJECTIVE: To collate the research reported on the various hazards associated with the ultrasonic dental scaler and discuss possible future research areas. DATA SOURCES: The scientific literature was searched using Web of Science, EMBASE and Medline, and the results of these were then hand-searched to eliminate nonrelevant papers. CONCLUSIONS: This review outlines some of the research conducted into these areas of associated hazard in order to assess their significance in the clinical situation, and discusses ideas for future research. Suggestions of recommendations are given, which have been previously investigated for their aid in reducing possible hazards, to ensure the safe working of ultrasonic scalers in the dental practice.
Air Microbiology↗
Ultrasonic scaler tip performance under various load conditions.
OBJECTIVES: The aim of this investigation was to assess the effect of loading on ultrasonic scaler tip displacement amplitude, using a scanning laser vibrometer. MATERIAL AND METHODS: Four generators were selected for this investigation including: Cavitron Select (Dentsply), Cavitron SPS (Dentsply), Piezon Master 400 (EMS) and Mini Piezon (EMS). The insert designs used with these generators included the TFI-10 and TFI-3 (with the Dentsply generators) and P-tip (with the EMS generators). The insert tips were contacted against tooth surfaces with loads of 0.25, 0.5 and 1.0 N. The scanning laser vibrometer was then used to scan the vibrating scalers at various generator power settings. RESULTS: The tips generally showed an increase in displacement amplitude with increasing power setting, although this increase was often nonlinear. Displacement amplitudes of like tips were generally found to be significantly different from each other at all loads. For individual inserts, loading caused a significant difference in tip response from the unloaded situation and also between loads. CONCLUSIONS: This investigation has demonstrated that there is a high variability associated with dental ultrasonic scaler inserts. Clinicians and researchers should be aware of this variability as it may affect both clinical procedures and future research.
Analysis of Variance↗