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Biomedical subjects

M R Brickley

Publications and source records attributed to M R Brickley.

36 records · Page 2Linked to original sources
PubMed1997

Agreement between practitioners concerning removal of asymptomatic third molars.

OBJECTIVE: To investigate and compare agreement within two groups of dental practitioners, family dentists and oral surgeons, in their decisions regarding removal of asymptomatic mandibular third molars. SUBJECTS: Ten oral surgeons and 18 family dentists from South Wales with experience ranging from 5 to 28 years. METHODOLOGY: Participants were presented with periapical radiographs of 36 asymptomatic, mandibular third molars and were informed of the age and gender of the patients and the degree of eruption of the third molars. Participants were asked to indicate whether they thought that the third molar should be removed or not. The degree of agreement between participants was measured by kappa indices for multiple raters. RESULTS: The kappa indices were 0.14 for the oral surgeons and 0.09 for the family dentists, indicating poor agreement beyond chance. Although in most cases the participants decided not to remove the third molar, they did so inconsistently, that is, they did not make this decision on the same cases. There were also differences in the inclination of the participants to suggest removal of the 36 third molars. CONCLUSION: Poor inter-observer agreement suggested that treatment decisions regarding asymptomatic third molars are based more on subjective beliefs and habitual practices than on rational decision making.

Adult↗
PubMed1996

An investigation of the rationality of lower third molar removal, based on USA National Institutes of Health criteria.

The appropriateness of surgical removal of lower third molars was audited in relation to 500 consecutive patients referred to hospital for third molar management during 1993/4. The National Institutes of Health (NIH) criteria were used as the validating standard. Immediately after patients had been seen for treatment planning, research workers repeated history taking and clinical examination and recorded the treatment that was planned. Appropriateness of treatment planning was then assessed. A total of 95% of patients had bilateral and 5% had unilateral lower third molars (976 teeth in all); 69% were partially erupted, 35% unerupted and 5% fully erupted. There was a weak correlation between eruption status of bilateral third molars. The most frequent reason for removal of third molars (31%) was pericoronitis, though the next most frequent reason was that the contralateral tooth had been scheduled for removal under general anaesthesia. Allowing this as a legitimate reason for surgery, of 859 teeth scheduled for removal, 59% were justified according to NIH criteria. Some 169 (34%) of patients might have avoided surgery altogether if NIH criteria had been the basis for intervention and a further 147 (30%) could have been scheduled for removal of only one lower third molar. These findings suggest that criteria for removal other than NIH criteria are being applied. Further research is necessary to identify these.

Adolescent↗
PubMed1996

Measurement of patient-derived utility values for periodontal health using a multi-attribute scale.

Periodontal health states are difficult to quantify and no formal scale quantifying patients' utilities for periodontal health states exits. Multi-attribute utility (MAU) techniques were used to develop such a scale. The MAU scale may be used to quantify patients' assessment of their current periodontal health and that of possible treatment outcomes. Such data, combined with probability values in formal decision analysis techniques would result in improved rationality of treatment planning for periodontal disease. 20 patients attending for routine undergraduate care were interviewed. Data from these interviews were sorted into groups of common interest (domains). Intra-domain health statements were complied from the interview content. 21 patients ranked the intra-domain statements on a scale of 0-100. This same group of patients also performed an inter-domain weighting. Mean results showed that patients were 2X as concerned with how they felt and with the prognosis of possible outcomes, than with how they looked and what facts they knew about their oral health. However, the real value of utilities research lies in application of individual results to treatment planning as there is a wide range of opinion regarding outcome health states.

Adult↗
PubMed1996

Performance of a computer simulated neural network trained to categorise normal, premalignant and malignant oral smears.

The accurate detection of malignant neoplasms whilst they are still small is recognised as one of the main factors increasing chances of survival. Neural networks have many biomedical applications and they have been applied to neoplasia but their use in oral pathology has only recently been documented. The objectives of this study were to train networks to discriminate between normal and dysplastic mucosa. Each network was trained by back propagation, internal cross validation and tested on additional data. The data were derived by analysing 348 intra-oral smears and included mean nuclear and mean cytoplasmic areas of the smears measured by image analysis. A neural network differentiated between normal/non-dysplastic mucosa and dysplastic/malignant mucosa (specificity 0.82, sensitivity 0.76). These early results suggest that integrating neural networks and image analysis, as well as investigating additional criteria, could enhance automation and accuracy of smear techniques in diagnosing oral malignancy.

Automation↗
PubMed1996

Patient perceptions regarding the risks of morbidity and complications of lower third molar removal.

The risks associated with third molar surgery are well established. Current philosophy stresses co-development of treatment plans with patients, who need to understand the complications and risks of possible treatment. This understanding was therefore investigated at an initial outpatient appointment (n = 91) after a verbal explanation and immediately prior to surgery (n = 73), by means of visual analogue scales to assess patients' perceptions of the likelihood of each outcome. Most patients (98 percent) responding at an initial appointment (t1) felt that they had been given enough information regarding reasons for removal but the proportion was lower (88 percent) for patients responding at the time of surgery (t2). This reduction was also found for information regarding post operative pain, swelling, trismus and nerve damage. Patients estimated the likelihood of pain as t1 = 70 percent, t2 = 80 percent, swelling t1 = 76 percent, t2 = 75 percent, trismus t1 = 74, t2 = 73 percent, temporary nerve damage: transient labial t1 = 46 percent, t2 = 33 percent, transient lingual t1 = 51 percent, t2 = 41 percent, and permanent nerve damage: labial t1 = 13 percent, t2 = 7 percent, lingual t1 = 14 percent, t2 = 9 percent. At t1 and t2 the mean perceived likelihood for pain, swelling and trismus were significantly higher than the known prevalence of these sequelae. The mean values for temporary lingual and labial anaesthesia were considerably higher (P < 0.05) than the reported prevalence. It was concluded that patients overestimated the likelihood of post operative complications and that these estimates varied with time. The validity of patients' estimates might be improved by verbal explanation supplemented by provision of written information.

Appointments and Schedules↗
PubMed1996

Prevalence of third molars in dental practice attenders aged over 35 years.

There is a lack of information in the United Kingdom on the prevalence of third molars in older patients. The aim of this study was therefore to define the pattern of lower third molar retention in UK dental practice attenders aged 35 years and over. A random sample of 599 eligible patients from a rural dental practice were included in the study. Information was obtained from clinical notes and panoramic radiographs. Data collected included age, gender, presence or absence of lower third molars, number of teeth present in the lower arch and eruption status. Two hundred and sixty-four (44.1 per cent) had at least one lower third molar present (mean age = 57.1 years) while 335 (55.9 per cent) had no lower third molars (mean age = 50.2 years). The data suggest that a greater proportion of men than women retain at least one lower third molar although this finding was not statistically significant. Seventy per cent of retained lower third molars reported in the study were fully erupted. Sixty per cent were vertically placed. There was an association between age and number of teeth present (chi 2 = 38.85, 4DF, P < 0.05), older patients having fewer lower teeth. These data suggest that a large number of patients can expect to keep their lower third molars beyond the age of 35 years and that in many cases a conservative "wait and see' policy for lower third molars in the early twenties is appropriate.

Adult↗
PubMed1995

The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients.

To assess the effect of alcohol intoxication on injury severity and head injury assessment, blood alcohol concentrations (BAC) were related to the severity of injuries (Injury Severity Score and Assault Trauma Score) and Glasgow Coma Scores (GCS) in 242 consecutive victims of weekend, night-time assault, none of whom had head injuries. No correlation was found between degree of intoxication and severity of injury. There was a highly significant correlation between BAC and GCS. However, high BACs (greater than 240 mg/100 ml) were associated with only a 2-3 point reduction in GCS. The median BAC in patients with a normal GCS was 115 mg/100 ml. Neurological assessments need to take account of the highly variable, depressive effects of alcohol.

Adolescent↗
PubMed1995

A new method of assessment of clinical teaching: ROC analysis.

Twenty-five clinical dental students with varying clinical experience were presented with case records consisting of a clinical history and a panoramic radiograph for 25 patients with bilateral lower third molars ('wisdom teeth'). The students were asked to indicate how certain they were that each lower third molar tooth needed removal using a 6-point rating scale. Immediately following the task, the students were presented with information on the indications for removal of lower third molars in the form of a lecture by a senior academic clinical teacher. One week later the students were asked to repeat the rating study, under the same conditions as before, using a further 25 clinical cases. Receiver operating characteristics (ROC) analysis, which provides a graphical and quantitative assessment of a group of observers' ability to detect need for treatment, was utilized to examine differences between junior and senior students and between the matched pre-training and post-training experiments. The ability of junior students to assign lower third molars for surgery was statistically no better than random selection of cases. Formal clinical teaching significantly improved this group's performance, but had no effect on the performance of senior students. Senior students were significantly better able correctly to assign lower third molars for surgical intervention than junior students. Therefore this study shows that clinical experience has a significantly greater influence on treatment-planning ability than formal teaching. ROC analysis is a useful tool for assessing the effectiveness of methods of undergraduate training.

Education, Dental, Graduate↗
PubMed1995

A technique for the computerized identification of orthodontic instruments.

Increasingly, orthodontic instruments must leave the chairside or even the clinic in order to facilitate adequate sterilization. The tray system employed in an orthodontic clinic is outlined. Inevitably, there are problems with instruments being lost from these trays and finding some method for individual 'tagging', which is also resistant to autoclaving, would be a useful facility. To address this problem a robust procedure of automatic instrument identification, similar to bar coding, has been deployed. This system, termed matrix coding, not only facilitates easy instrument identification, but also allows every episode of clinical use and sterilization to be recorded. By such a method it could become possible to quickly establish when instruments are likely to require servicing, sharpening or replacement.

Computers↗
PubMed1995

Healthy decision making: a new approach in health promotion using health state utilities.

Empowerment of the individual is the central tenet of health promotion philosophy. Application of health state utility methodology to clinical decisions will facilitate this process. The study reported here used health state utilities to examine the preferences of young adults concerning third molar care. Respondents were asked to indicate the strength of their preferences for various outcomes consequent to removing, or not removing these teeth by using standardised visual analogue scales. The results demonstrated that health state utilities for most complications of surgery were lower than, and therefore reduced health more than, those associated with the complications of leaving teeth in place. Therefore dental surgeons should be more circumspect about surgical intervention: this group of potential patients believed that the 'cure' is often worse than the 'disease'. This study illustrates the use of health state utilities, a methodology which allows patients' perspectives to be incorporated into the planning of rational health care.

Adult↗
PubMed1994

Risk of occupational glass injury in bar staff.

One hundred and twenty-six bar staff (median length of service 2.7 years) working in 42 randomly selected public houses in South Glamorgan were interviewed and examined in the workplace to investigate the incidence, characteristics and treatment of lacerations from bar glassware. 41 per cent reported previous injury, 13 per cent on five or more separate occasions. All injuries but one were of the hand. After 13 per cent of incidents, treatment had been sought in an A & E department, but 58 per cent of incidents causing hand lacerations were not treated. Straight-sided (nonik) one pint (0.6 l) capacity glasses were responsible for two-thirds of injuries, usually during stacking and washing of used glasses. Of bar-workers familiar with toughened glassware, 86 per cent favoured its use on safety grounds. It was concluded that the incidence of sharps (glass) injury was unacceptably high and that this was also a potential cause of cross-infection in this group of workers.

Accidents, Occupational↗
PubMed1994

Automatic identification of surgical and orthodontic instruments.

Surgical instruments are becoming increasingly expensive and represent an important component of the costs of operating theatres. The use and processing of surgical instruments in decontamination and packaging units and in the operating theatre need to be monitored, both to improve efficiency and to allow measurement of the effectiveness of training in operative technique. Automatic identification of surgical and orthodontic instruments was therefore performed using two standard methods: the two-dimensional bar-code and matrix code. Encryption (the formulation of codes), was carried out prior to bar and matrix coding using acid-etch and laser techniques respectively. 'Reading' of the two types of code was more difficult with bar-codes because of the high reflectivity of background polished stainless steel, and only large instruments had sufficient area for bar-coding. Consistent, accurate, automatic identification of the instruments was possible with the matrix code for which a surface of only 4 sq mm is necessary. After 50 cycles of decontamination and packaging, neither code showed obvious deterioration and it was possible to read the matrix code as easily as prior to this process. Automatic instrument identification is possible using recently developed methods and could facilitate economies in the processing of instruments in health facilities and the automatic recording of instrument usage in the operating theatre.

Electronic Data Processing↗
PubMed1990

Alcohol abuse in dental patients.

Alcohol abuse is an important problem in Britain and is imposing increasing burdens both in general practice and in the hospital service. In the absence of previous investigations of the prevalence of intoxication and dependence in dental patients, 225 consecutive patients who attended the University of Bristol Dental Hospital were interviewed and examined: 75 attended for primary care, 75 for consultation at an oral surgery clinic, and 75 for elective minor oral surgery. A group of 50 consecutive dermatology out-patients were used as controls. All patients were breath analysed to determine blood alcohol concentrations. Dependence was assessed with the CAGE self-administered questionnaire. Eleven per cent of patients showed evidence of alcohol dependence, a similar proportion to that which has been demonstrated in the population of England and Wales overall. Dependent patients attended more often in the morning (71%) than in the afternoon (29%). Only four (1%) of all 275 patients showed evidence of blood alcohol (range 5-90 mg/100 ml): three who attended in the afternoon and one who attended at 9 am. No patient reported recent alcohol intake to allay anxiety. There were no significant differences between groups of patients with regard either to intoxication of dependence.

Adolescent↗
PubMedDate not supplied

Lower third molar treatment planning ability of general dental practitioners and oral maxillofacial surgeons using receiver operating characteristics methodology.

A comparison of lower third molar treatment planning ability of six oral and maxillofacial surgeons (three consultants, two senior registrars and one senior house officer) and 27 general dental practitioners was carried out using Receiver Operating Characteristics (ROC) methodology. Each clinician was presented with the same series of 50 case histories and asked to indicate, using a rating scale, how certain they were that each lower third molar required removal. These data, together with NIH gold standard treatment decisions for each third molar, were then used to construct ROC curves for each clinician and, using combined data, to produce ROC curves for the groups of hospital specialists and general dental practitioners. These curves were then compared statistically. There were significant differences between the best and worst practitioners, both in the hospital service and within general dental practice. When combined data were examined, however, there was no statistical difference in the treatment planning ability of hospital specialists and general dental practitioners. These findings indicate that lower third molar treatment planning ability is more dependent upon individual factors than specialist training. Further, the data presented here suggest that general dental practitioners are as capable of treatment planning for lower third molars as the specialists to whom they refer.

Clinical Competence↗
PubMedDate not supplied

Performance of a neural network trained to make third-molar treatment-planning decisions.

The authors developed and tested 12 neural networks of different architectures to make lower-third-molar treatment-planning decisions, using a software-based neural network (Neudesk 1.2, Neural Computer Sciences, Southampton, UK). Network training was undertaken using clinical histories from 119 patients (with 238 lower third molars) referred for treatment planning (79 females and 40 males, mean age 25 years) together with output data consisting of actual treatments planned by a senior oral surgeon. Both the input clinical data and the consultant decisions were treated on a tooth-wise basis and were coded to numerical values. Binary data (e.g., present/absent) were coded to 1 and 0, while quantitative data (e.g., age) were scaled to fall between 0 and 1. A network based on the optimal architecture was trained and then interrogated with test data derived from a further 174 patients (119 females and 55 males, mean age 26 years) with 348 lower third molars. Network decisions were dichotomized with a threshold of 0.8. With no knowledge of the network decisions, the senior oral surgeon indicated his preferred treatments. The teeth were then assigned to "gold-standard" categories of indications present or absent based on National Institutes of Health consensus criteria. Against this, the network achieved a sensitivity of 0.78, which was slightly inferior to that of the oral surgeon (0.88), although this difference was not significant, and a specificity of 0.98, compared with 0.99 for the oral surgeon (p = NS). Agreement between the oral surgeon and network decisions was very high (kappa = 0.850). This study demonstrates that it is possible to train a neural network to provide reliable decision support for lower-third-molar treatment planning.

Adult↗