bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing primary health clinical teams for public oral health services in Tasmania
Authors: Cane RJ , Butler DR
Published: March 2008

This paper reviews the problem of socio‐economic health inequalities and highlights the relevance of these issues for the delivery of public oral health services in the Australian island State of Tasmania. It contends that unless there is reform of existing public oral health systems, inequities in oral health care linked to socio‐economic factors and geographic location will remain. The challenge is, firstly, to understand the current situation and why it has occurred. Secondly, we need to ensure that this understanding is shared across educational and professional sectors for the development of innovative approaches to the problem. Thirdly, we must carry out preliminary research and evaluation for any reforms. Using a combination of approaches, i.e., primary health care, a ‘common risk’ approach and increasing workforce numbers has been identified as a method showing the most potential to improve access to equitable oral health care. An outline of a current research project evaluating the impact of the integration of primary oral health care clinical teams into public oral health services is provided. The clinical teams combine the skills of the dentist and an expanded role for dual trained dental therapists/dental hygienists. The teams focus on the development of innovative clinical practice in the management and prevention of common oral diseases that take into account the broader determinants of oral health inequality. This project will be conducted in Tasmania, where the dominance of small rural and remote communities, adverse socio‐economic factors and shortage of oral health professionals are key issues to consider in planning public oral health services and programmes. The results of the evaluation of the Tasmanian pilot model will contribute to the evidence base that will support the introduction of new approaches to public oral health care.
The growth of the nasal septum in the 6–9 week period of foetal development—Warfarin embryopathy offers a new insight into prenatal facial development
Authors: Howe AM , Hawkins JK , Webster WS
Published: March 2008

Background The aim of this study was to determine the role of the nasal septum in embryonic facial development.

Methods Nasal septal growth and facial profile development were examined in sagittally‐sectioned 6–9 week human foetuses and compared to previously published data for later prenatal periods. To complement this data a cephalometric study of a child with untreated warfarin embryopathy was undertaken since a previous study in rats had shown warfarin exposure interferes with septal growth.

Results The results showed that prenatal septal growth was maximal during the 6–9 week period and resulted in the establishment of a facial profile that was maintained until birth. This critical period of growth corresponds to the period of warfarin exposure of the human foetus that results in the warfarin embryopathy. The cephalometric examination of a child with untreated warfarin embryopathy showed a combination of short anterior cranial base and a short maxilla had contributed to a significant retrusion of the maxilla suggestive of failure of the midface to develop over the 6–9 week period.

Conclusion These findings would support the hypothesis that the nasal septum plays an active role in embryonic midfacial development.
Longevity of a resin‐modified glass ionomer cement and a polyacid‐modified resin composite restoring non‐carious cervical lesions in a general dental practice
Authors: Smales RJ , Ng KKW
Published: March 2008

Background Long‐term prospective survival studies of resin‐modified glass ionomer cements (RMGICs) and polyacid‐modified resin composites (compomers) placed in non‐carious cervical lesions (NCCLs) are lacking from general dental practice. Short‐term studies have shown an unsatisfactory clinical performance for several materials.

Methods One practitioner placed 87 compomer (Compoglass, Vivadent‐Ivoclar) and 73 encapsulated RMGIC (Fuji II LC, GC Int.) restorations in NCCLs for 61 adults. Compoglass was placed using SCA primer, and Fuji II LC using GC Dentin Conditioner. No cavity preparation was undertaken. The Kaplan‐Meier method was used for estimating the cumulative survivals for those restorations that were replaced, with the probability level set at a=0.05 for statistical significance.

Results Restorations were judged unsatisfactory (by the practitioner and the subjects) because of surface and marginal loss of material (68.8 per cent), dislodgement (18.8 per cent) and discoloration (12.4 per cent), these modes being similar for both materials (P=0.35). Unsatisfactory restorations were replaced in 121 (75.6 per cent) instances. After periods of up to five years, cumulative survival estimates were 14.9 (5.8 Standard Error) per cent for Compoglass and zero per cent for Fuji II LC (P=0.74). Median survivals were 30 months for Compoglass and 42 months for Fuji II LC.

Conclusion Both materials had high long‐term unsatisfactory performances when placed in non‐ prepared NCCLs in a general dental practice.
Burning mouth syndrome: an update on recent findings
Authors: Barker KE , Savage NW
Published: March 2008

Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of mucosal abnormality. Various local, systemic and psychological factors are associated with BMS, but its aetiology is not fully understood. Recently, significant inroads have been made, producing a better understanding of this complex condition. The aim of the current paper is to explore the condition of BMS in an educational context with the specific outcome of increasing awareness of the condition.
An in vitro model to measure the effect of a silver fluoride and potassium iodide treatment on the permeability of demineralized dentine to Streptococcus mutans
Authors: Knight GM , McIntyre JM , Craig GG , Mulyani  , Zilm PS , Gully NJ
Published: March 2008

Background: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been used to reduce the incidence of caries in primary dentitions but has been limited by the associated staining of both teeth and restorative materials. The application of potassium iodide (KI), following AgF prevents staining but its effects on the ability of AgF to reduce caries are not known. The aim of this study was to develop an in vitro model that would provide an indication of the permeability of demineralized dentine to Streptococcus mutans after treatment of the dentine with AgF followed by KI.

Methods: Forty dentine discs were bonded to the base of forty 5mL polycarbonate screw top vials (that had had their bases removed), filled with nutrient medium, sterilized and placed into a continuous culture of S. mutans. Samples were divided into four groups as follows: 10 samples of demineralized dentine as a control, 10 samples of demineralized dentine treated with AgF/KI, 10 samples of demineralized dentine treated with KI and 10 samples of demineralized dentine treated with AgF. After two weeks the optical density of the growth medium chambers was measured to determine bacterial penetration and growth. Cultures were plated out to determine migration through the discs by S. mutans.

Results: S. mutans migrated through all dentine discs. However, the samples treated with AgF and AgF/KI had significantly lower optical densities than the corresponding controls. The range of optical densities was least amongst demineralized samples treated with AgF/KI.

Conclusions: Under the conditions of this study, treatment of demineralized dentine discs with AgF followed by KI allowed the penetration of S. mutans. Based on optical density measurements, the treatment resulted in significantly fewer microorganisms being present subjacent to the discs treated with AgF and KI than the control discs at the end of the experimental period.
Pre‐school child oral health in rural Western Australia
Authors: Kruger E. , Dyson K. , Tennant M.
Published: March 2008

Background: In light of the various challenges faced by public dental health services, especially when large geographical areas and isolated communities are concerned, targeting of high risk groups within these populations needs to be investigated. This study aimed to assess caries experience, dental health behaviour and dental service utilization among a sample of pre‐school children in a rural community in Western Australia.

Methods: The study was a cross‐sectional oral health survey of pre‐school children between the ages of 2 and 5 in Carnarvon, Western Australia.

Results: In total, 70 pre‐school children (representing approximately 15 per cent of the total 2–5 year old population of Carnarvon) were examined. Less than half of the children were caries free. Both caries prevalence and severity (mean dmft) were significantly higher among Aboriginal children than non‐Aboriginal children. Caries prevalence and severity were also significantly higher among children who often consumed carbonated drinks.

Conclusions: This survey indicates that some preschool children in rural areas, and especially Aboriginal pre‐school children, are at high risk of developing dental caries. Effective oral health programmes commencing well before the usual first contact with dental services at age 5 are needed for young children at high risk of dental caries.
Drugs for pain management in dentistry
Authors: Hargreaves K. , Abbott P V
Published: March 2008

Pain is one of the most common reasons patients seek dental treatment. It may be due to many different diseases/conditions or it may occur after treatment. Dentists must be able to diagnose the source of pain and have strategies for its management. The ‘3‐D’ principle — diagnosis, dental treatment and drugs — should be used to manage pain. The first, and most important, step is to diagnose the condition causing the pain and identify what caused that condition. Appropriate dental treatment should then be undertaken to remove the cause of the condition as this usually provides rapid resolution of the symptoms. Drugs should only be used as an adjunct to the dental treatment. Most painful problems that require analgesics will be due to inflammation. Pain management drugs include non‐narcotic analgesics (e.g., non‐steroidal anti‐inflammatory drugs, paracetamol, etc) or opioids (i.e., narcotics). Non‐steroidal anti‐inflammatory drugs (NSAIDs) provide excellent pain relief due to their anti‐inflammatory and analgesic action. The most common NSAIDs are aspirin and ibuprofen. Paracetamol gives very effective analgesia but has little anti‐inflammatory action. The opioids are powerful analgesics but have significant side effects and therefore they should be reserved for severe pain only. The most commonly‐used opioid is codeine, usually in combination with paracetamol. Corticosteroids can also be used for managing inflammation but their use in dentistry is limited to a few very specific situations.
Oral candidosis and the therapeutic use of antifungal agents in dentistry
Authors: McCullough MJ , Savage NW
Published: March 2008

This paper reviews the current concepts of mycology and candidal infections as they relate to the oral cavity. Proposed classification for the presentation of oral candidosis is outlined as are examples of these topical infections, such as erythematous, pseudo‐membranous and hyperplastic candidosis, as well as angular chelitis and median rhomboid glossitis. The diagnosis and principles of management of oral candidosis are discussed, the therapeutic agents available for the management of these infections are presented and a treatment protocol for the management of patients with oral candidosis is given.
Topical corticosteroids in dental practice
Authors: Savage NW , McCullough MJ
Published: March 2008

Topical corticosteroids represent an important therapeutic aid in the management of a range of oral mucosal disease conditions. Like all medications, their successful use depends upon an understanding of the disease process. This includes an appropriate diagnosis, a clear view of the desirable treatment outcomes and knowledge of whether treatment is aimed at management of a chronic disease or enhanced resolution of a short‐term condition. This paper reviews the use of topical corticosteroids and their possible roles in the management of oral disease.
Antibiotic prophylaxis for endocarditis: time to reconsider
Authors: Singh J. , Straznicky I. , Avent M. , Goss AN
Published: March 2008

Some cardiac conditions require antibiotic prophylaxis for some types of dental treatment to reduce the risk of infective endocarditis (IE). All medical and dental practitioners are familiar with this practice but tend to use different regimens in apparently similar circumstances. Generally, the trend has been to prescribe antibiotics if in doubt. This review explores the evidence for antibiotic prophylaxis to prevent IE: does it work and is it safe? The changing nature of IE, the role of bacteraemia of oral origin and the safety of antibiotics are also reviewed. Most developed countries have national guidelines and their points of similarity and difference are discussed. One can only agree with the authority who describes antibiotic guidelines for endocarditis as being ‘like the Dead Sea Scrolls, they are fragmentary, imperfect, capable of various interpretations and (mainly) missing!’ Clinical case‐controlled studies show that the more widely antibiotics are used, the greater the risk of adverse reactions exceeding the risk of IE. However, the consensus is that antibiotic prophylaxis is mandatory for a small number of high‐risk cardiac and high‐risk dental procedures. There are a large number of low‐risk cardiac and dental procedures in which the risk of adverse reactions to the antibiotics exceeds the risk of IE, where prophylaxis should not be provided. There is an intermediate group of cardiac and dental procedures for which careful individual evaluation should be made to determine whether IE or antibiotics pose the greater risk. These categories are presented. All medical and dental practitioners need to reconsider their approach in light of these current findings.
Cardiac murmurs: echocardiography in the assessment of patients requiring antibiotic prophylaxis for dental treatment
Authors: Ching M. , Straznicky I. , Goss AN
Published: March 2008

Background: Traditionally patients who indicate that they have a heart murmur or who indicate that they have had rheumatic fever are given antibiotic prophylaxis for dental treatment. This is commonly done without further assessment of the patient's actual endocarditis risk. Echocardiography is a non‐invasive method of assessing cardiac valve function and haemodynamics.

Methods: Consecutive patients who were referred to a private practice oral and maxillofacial surgeon for dentoalveolar surgery and indicated that they had a cardiac problem and usually had antibiotic prophylaxis, were evaluated. Those with a clear indication for prophylaxis, for example had prosthetic heart valves or previous infective endocarditis, received antibiotic prophylaxis. Where there was uncertainty, they were referred for an echocardiogram, and if abnormal, a formal cardiology review.

Results: Three hundred and seventy patients out of approximately 20 000 (1.85 per cent) indicated that they had a cardiac murmur and usually received antibiotic prophylaxis for dental treatment between 1 February 1997 and 1 February 2005. Two hundred and sixty‐two (71 per cent) were female and 108 (29 per cent) were male; age range 0.7 to 98 years, average 37.6 years. Two hundred and seventy (72 per cent) had normal hearts with no indication for antibiotic prophylaxis. Of the 100 (28 per cent) patients with abnormal findings, they were on average older; 49.5 years, range 0.7 to 87 years. Of these, 50 (14 per cent) met current indications for antibiotic prophylaxis.

Conclusion: Patients who present for dental treatment indicating that they require antibiotic prophylaxis for cardiac condition need to be fully evaluated. In this study only 50 of 370 patients (14 per cent) required antibiotic prophylaxis. The remaining 320 (86 per cent) would have no benefit but a risk of adverse reaction to the antibiotic.
Severe odontogenic infections
Authors: Uluibau IC , Jaunay T. , Goss AN
Published: March 2008

Background: Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.

Methods: All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre‐presentation history, surgical and anaesthetic management and outcome was obtained and analysed.

Results: Forty‐eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty‐four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.

Conclusion: Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.
Cryotherapy for treatment of oral lesions
Authors: Farah CS , Savage NW
Published: March 2008

Cryotherapy is the deliberate destruction of tissue by application of extreme cold. It is well received by patients due to a relative lack of discomfort, the absence of bleeding and minimal to no scarring after healing. It has many applications in oral medicine and clinical oral pathology, and is extremely useful in patients for whom surgery is contra‐indicated due to either age or medical history. In this paper we outline the principles, mechanisms of action, and current applications of cryotherapy in the treatment of oral lesions, and present some clinical cases.
Dental therapy in Western Australia: profile and perceptions of the workforce
Authors: Kruger E. , Smith K. , Tennant M.
Published: March 2008

Background: In 2002, the Centre for Rural and Remote Oral Health (CRROH) completed a rural oral health workforce survey which indicated that a high number of therapists, although registered, were not working as therapists. The aim of the present study was to develop a profile of the dental therapy workforce and analyse the perceptions of therapists.

Methods: In 2004, a postal questionnaire survey was undertaken amongst all registered dental and school dental therapists for 1999, 2000, 2001, 2002 and 2003.

Results: Valid information was obtained from 253 therapists (55 per cent response rate). The therapy workforce are almost exclusively female, have an average age of 40 years, are working in urban areas, obtained their qualification on average 20 years ago, work for the School Dental Service and qualified in Western Australia. More than a quarter no longer worked as therapists. Perceptions regarding the advantages and disadvantages of dental therapy as a career were identified.

Conclusions: When trying to promote dental therapy and school dental therapy as a career, retain therapists and recruit new graduates, the opportunities identified in this survey should be embraced. A clear focus on the issues will be required to facilitate meeting the workforce objectives as outlined in Australia's National Oral Health Plan.
Epidemiological analysis of tongue cancer in South Australia for the 24‐year period, 1977–2001
Authors: Lam L. , Logan RM , Luke C.
Published: March 2008

Background: Tongue cancer (141 ICD‐9) is the most common intra‐oral malignancy in Western countries. In recent decades, reported tongue cancer incidence and mortality rates have increased both in Europe and in the United States, whilst survival has not improved. This study aimed to determine the epidemiology and survival trends of tongue cancer in South Australia over the 24‐year period from 1977 to 2001.

Methods: Population‐based data for tongue cancer were provided by the Central Cancer Registry Unit of the Epidemiology Branch of the South Australian Department of Health. Age‐standardized incidence and mortality rates for males and females were calculated. Kaplan‐Meier survival analysis was conducted according to time periods, age, sex and tongue sub‐sites. Cox regression analysis was used to determine factors that influenced survival.

Results: During this 24‐year period, 611 cases of tongue cancer (398 males, 213 females) were reported, the majority of which were squamous cell carcinomas. The most common age of diagnosis was 65–69 years in males and 60–64 years in females. Fifty cases (8.18 per cent of all tongue cancer cases) occurred in patients 40 years or younger. The most common cancer sub‐sites reported were ‘unspecified site’ (48.45 per cent), lateral border (25.53 per cent) and base (18.49 per cent) of the tongue. The age‐standardized incidence and mortality rates for males and females in South Australia were relatively low and stable, and there was no significant improvement in survival of tongue cancer over this period. Significant predictors for survival were sex, age and tongue sub‐sites, with male, advanced age and base of tongue associated with poorer survival.

Conclusions: Tongue cancer is an important health issue associated with poor survival. Early detection and diagnosis is important in order to improve survival rate for this malignancy.
The effect of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine
Authors: Knight GM , McIntyre JM , Mulyani
Published: March 2008

Background: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been shown to reduce the incidence of caries in primary dentitions. The clinical application of this material has been limited by staining associated with both teeth and restorative materials. The application of potassium iodide (KI) after AgF eliminates stain formation. There is a lack of information as to how the addition of AgF followed by KI may affect the bond strength to dentine. The purpose of this study was to compare the bond strengths of auto cure glass ionomer cement to dentine surfaces that had been treated with AgF and KI and without treatment.

Methods: Ten recently extracted human third molars were embedded into methyl methacrylate resin and sliced to form a square block of exposed dentine surfaces. Each of the four surfaces were treated by one of the following procedures: (a) etching with 37 per cent phosphoric acid; (b) applying GC dentine conditioner; (c) etching, followed by application of AgF/KI then washing off the precipitate and air drying; and (d) etching, applying AgF/KI and air drying the reaction products on the surface. Fuji VII auto cure glass ionomer cement was bonded onto each sample and fracture tested.

Results: The dentine samples treated with AgF/KI followed by washing away the precipitate and air drying had bond strengths (2.83MPa) not significantly different from samples that had been conditioned (2.40MPa). Samples where the AgF/KI precipitate had been air dried onto the dentine surface had significantly lower bond strengths (1.49MPa) than the washed samples. Samples that were etched had significantly lower bond strengths (1.91MPa) than the conditioned samples.

Conclusions: This study found that the application of AgF/KI to etched dentine samples followed by washing off the precipitate, created bond strengths that were not significantly different to conditioned samples. Leaving the AgF/KI precipitate on the dentine surface significantly reduced the bond strength of auto cured glass ionomer cement to dentine. Washing away the reaction products and air drying is recommended as the clinical protocol for using AgF and KI on dentine surfaces prior to application of an auto cure glass ionomer cement.
Reaction of rat pulp tissue to Carisolv ‘new gel’—‐A histocytological evaluation
Authors: Dammaschke T. , Stratmann U. , Danesh G. , Schäfer E. , Ott KHR
Published: March 2008

Background: This study was an histological examination of pulp tissue exposed to Carisolv ‘new gel’ after 1 to 28 days.

Methods: An occlusal cavity was prepared in 64 caries‐free molar teeth of 16 Wistar rats. The roofsof the pulp chambers were perforated and Carisolv ‘new gel’ solution was placed onto the exposed pulps of 32 molar teeth for 20 minutes. Thirty‐two contralateral molar teeth served as controls and were coated with an inert liquid containing isotonic saline solution and carmellose for 20 minutes as well. The pulps of all teeth were capped with Ca(OH)2 and the cavities were filled with a flowable composite in combination with a self‐etching dentine adhesive. The animals were sacrificed after 1, 3, 7 and 28 days. Eight teeth per group and the time period were histologically examined, scored, and statistically evaluated (Wilcoxon‐test).

Results: The results showed no statistically significant differences between the Carisolv group and the control group (p>0.05). The observed pulp reaction was essentially the same as those reported in the past being typical for the effect of calcium hydroxide as a direct pulp capping agent.

Conclusion: Compared to Ca(OH)2, Carisolv ‘new gel’ did not cause any different or additional pulp reaction in healthy teeth.
Methods of determining the relationship of the mandibular canal and third molars: a survey of Australian oral and maxillofacial surgeons
Authors: Koong B. , Pharoah MJ , Bulsara M. , Tennant M.
Published: March 2008

Background: Surgical extraction of third molars is one of the most common oral and maxillofacial surgical procedures performed and may have a number of associated complications. One of these complications is inferior alveolar nerve (IAN) dysaesthesia or impairment of sensory perception (including paraesthesia and/or anaesthesia). Previous studies assume that most clinicians use various combinations of nine radiologic criteria on panoramic radiographs as indicators of the relationship and, therefore, predictors of the risk of postoperative dysaesthesia. Our study assessed both the current radiologic modalities and assessment criteria used by Australian oral and maxillofacial surgeons when determining the proximity of mandibular canal to third molars.

Methods: A survey of all surgeon members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZOMS) practising in Australia was undertaken.

Results: Of the 105 questionnaires sent to surgeons, 72 responses (68 per cent) were returned. All surgeons reported using the panoramic radiograph but only 25 per cent considered it sufficiently accurate in determining the relationship between the mandibular canal (MC) and the third molar root, while 61 per cent of surgeons use CT for this purpose but the average frequency of use was very low (five per cent). This study also revealed that the nine radiologic criteria on a panoramic radiograph are used to varying extents by Australian surgeons. Nearly all surgeons use ‘change in MC direction’ and ‘MC narrowing’ to determine and close relationship. Thirty‐one per cent used super‐imposition of the MC and the root of the third molar alone and 24 per cent used appearance of contact of the root with the MC alone in the absence of any other radiologic criteria to indicate close or intimate relationship.

Conclusion: Further research is required to determine the accuracy and observer agreement or reliability of using the nine panoramic characteristics, to determine this relationship and whether the presurgical determination of proximity and position (buccal or lingual) of the canal utilizing CT has any usefulness in determining the surgical protocol or affect on postoperative morbidity.
Analysis of the acute postoperative pain experience following oral surgery: identification of ‘unaffected’, ‘disabled’ and ‘depressed, anxious and disabled’ patient clusters
Authors: Vickers ER , Boocock H. , Harris RD , Bradshaw J. , Cooper M. , Vickers P. , Cannon P.
Published: March 2008

Background: Pain is defined as both a sensory and an emotional experience. Acute postoperative tooth extraction pain is assessed and treated as a physiological (sensory) pain while chronic pain is a biopsychosocial problem. The purpose of this study was to assess whether psychological and social changes occur in the acute pain state.

Methods: A biopsychosocial pain questionnaire was completed by 438 subjects (165 males, 273 females) with acute postoperative pain at 24 hours following the surgical extraction of teeth and compared with 273 subjects (78 males, 195 females) with chronic orofacial pain. Statistical methods used a k‐means cluster analysis.

Results: Three clusters were identified in the acute pain group: ‘unaffected’, ‘disabled’ and ‘depressed, anxious and disabled’. Psychosocial effects showed 24.8 per cent feeling ‘distress/suffering’ and 15.1 per cent ‘sad and depressed’. Females reported higher pain intensity and more distress, depression and inadequate medication for pain relief (p<0.001). Distress and depression were associated with higher pain intensity. The developed questionnaire had tested reliability (test‐retest r=0.89) and estimated validity.

Conclusion: Cluster analysis showed constituent groups with a range of psychosocial effects in acute postoperative dental extraction pain and is associated with an increase in pain intensity.
Retention procedures for stabilizing tooth position after treatment with orthodontic braces
Authors: Littlewood SJ , Millett DT , Doubleday B. , Bearn DR , Worthington HV , SAMPSON WAYNE J
Published: March 2008

The Cochrane Collaboration is an international organization that aims to help people make well‐informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews on the effects of healthcare interventions. The Cochrane Oral Health Group aims to produce systematic reviews which primarily include all randomized control trials (RCTs) of oral health, including prevention, treatment and rehabilitation of oral, dental and craniofacial diseases and disorders. Full copies of the review papers can be accessed electronically at http:www.cochrane.orgreviewsindex.htm, clicking on ‘Login to the Cochrane Library’, followed by clicking on ‘Cochrane Reviews’, and selecting the appropriate review. This is a free service provided by the Australian Government.

The Australian Dental Journal publishes selected abstracts in each issue for our readers' interest. A detailed description of the activities of the Cochrane Oral Health Group, written by the Review Group Co‐ordinator, Dr Emma Tavender, was published in the June 2004 issue of the Journal (Aust Dent J 2004;49:58–59). Also, for explanations of abbreviations and terminology please see Appendix 1 on page 59 of the aforementioned article.

Editor
Longitudinal comparison of factors influencing choice of dental treatment by private general practitioners
Authors: Brennan DS , Spencer AJ
Published: March 2008

Background
: Service rate variations and appropriateness of care issues have focused attention on factors that influence treatment decisions. The aims of this study were to examine what factors dentists consider in choosing alternative treatments, the stability of these factors over time and whether stability of treatment choice was related to age of dentist.

Methods
: Baseline data were collected by mailed self‐complete questionnaires from a random sample of Australian dentists (response rate=60.3 per cent, n=345 private general practitioners provided service data from a typical day) in 1997–1998 and follow‐up data were collected in 2004 (response rate=76.8 per cent, n=177 matched longitudinal cases).

Results
: The most frequent factors considered important across six alternative treatment pair choice scenarios were caries rate for ‘exam v. x‐ray’, age of patient for ‘preventive v. restorative intervention’, cost of treatment for ‘crown v. buildup’, ‘root canal v. extraction’ and ‘bridge v. denture’, and calculus for ‘prophylaxis v. scaling’. The only differences over time were (t‐test, P < 0.05): higher proportions of responses in the mouth status group at follow‐up for ‘exam v. x‐ray’ higher proportions of responses in the visit history group at follow‐up for ‘preventive v. restorative intervention’ a lower proportion of responses in the caries group at follow‐up for ‘crown v. build‐up’ and a higher proportion of responses in the treatment constraints group at follow‐up for ‘prophylaxis v. scaling’. Conclusions: While a wide range of responses were offered as factors influencing the choice of alternative treatments, cost of treatment was a major consideration in situations where significantly cheaper alternatives existed, while patient preference was commonly included as a secondary consideration across a wide range of treatment choice scenarios. The treatment choice responses showed a high degree of stability over time across all age groups of dentists, suggesting that if routines are developed these are established before or soon after graduation as a dentist.
Risk factors for dental caries in the five‐year‐old South Australian population
Authors: Slade GD , Sanders AE , Bill CJ , Do LG
Published: March 2008

Background
: This study tested the hypothesis that risk behaviours in disadvantaged groups would explain socio‐economic inequality in dental caries prevalence among preschool children.

Methods
: Using a case‐control study, children with caries experience (one or more decayed, missing or filled primary tooth surfaces) and with no caries experience were sampled with known probabilities from among five year olds attending the South Australian Dental Service (SADS). Dental caries experience of primary teeth was recorded by SADS clinicians. Social and behavioural information was collected using a questionnaire mailed to parents. Prevalence rates, prevalence ratios (PR) and 95 per cent confidence intervals (95% CI) were computed, taking into account sampling probabilities.

Results
: Questionnaires were obtained for 64.6 per cent of sampled children (n=1398) and 40.2 per cent (95% CI=37.8–42.6) of them had caries experience. Five statistically significant risk factors were identified relating to previous feeding, current oral hygiene and parent's own oral health perceptions. The prevalence of four risk factors was greater in low‐income households compared with high‐income households (P?0.01). In multivariate analysis, after adjusting for age of tooth cleaning onset, age at which toothpaste was introduced was not significantly associated with caries prevalence. Behavioural risk factors did not explain income‐related gradients in caries prevalence but modified the level of risk associated with delayed onset of tooth cleaning. Children who delayed tooth cleaning until the age of 24 months or more and who were from low‐income households had a 2.7‐fold increase in caries prevalence (95% CI=2.1–3.4).

Conclusions
: Caries prevention efforts need to target behaviours in infancy and non‐behavioural risk factors among preschoolers in low‐income households.
The pH change after HCl titration into resting and stimulated saliva for a buffering capacity test
Authors: Moritsuka M. , Kitasako Y. , Burrow MF , Ikeda M. , Tagami J.
Published: March 2008

Background
: Saliva collection can provide clinical information about individual patients. However, a correlation between ranking buffering capacity using resting and stimulated saliva is still unknown. The aim of this study was to evaluate the pH change after HCl titration into resting and stimulated saliva for a salivary buffering capacity test.

Methods
: Resting and stimulated saliva (by chewing paraffin wax) were collected from 80 patients. After the pH of both saliva samples was measured using a hand‐held pH meter, the saliva samples were titrated with 0.1N HCl to evaluate the buffering capacity. Correlations of ranking buffering capacity (high, medium, low) between stimulated saliva and resting saliva with 30μL HCl titration and between stimulated saliva and resting saliva with 40μL HCl titration were statistically analysed by Spearman Rank Correlation Test (p < 0.05).

Results
: At 50μL HCl titration, stimulated saliva buffering capacities were ranked into high (above pH 5.5), medium (pH from 5.5 to 4.5) and low (below pH 4.5). At 30–40μL HCl titration, the resting saliva buffering capacities were ranked into the same categories. Spearman Rank Correlation indicated significant positive coefficients for the stimulated saliva and resting saliva buffering capacity at 30μL titration and the stimulated saliva and resting saliva at 40μL titration.

Conclusion
: Stimulated saliva is more resistant to variation in pH change during HCl titration than resting saliva. Stimulated saliva sampling is a good method to determine buffering capacity during a comprehensive oral health assessment.
Single‐visit more effective than multiple‐visit root canal treatment?*
Authors: HARGREAVES KEN M
Published: March 2008

Data sources
: Literature was searched using the Cochrane Controlled Trials Register (CENTRAL), Medline, Embase and HealthStar databases. Reference lists from identified articles were scanned and a further search made using names of authors of the identified articles. Papers that had cited these publications were also identified through the Science Citation Index to identify potentially relevant subsequent primary research.

Study selection
: Two reviewers scanned all titles and abstracts. An article was included if subjects had a no relevant medical history; subjects presented with mature teeth with infected necrotic root canals and radiographic evidence of periapical bone loss (as an indication of preoperative canal infection), all selected root canals had not received any endodontic treatment previously, participants underwent nonsurgical root canal treatment during the study, and the number of teeth showing radiographic evidence of healing was the outcome measure.

Data extraction and synthesis
: Data were abstracted by two reviewers. The principal measure of treatment effect was risk difference with the fixed‐effect method for combining study estimates being used to produce an overall estimate. Between‐study heterogeneity was assessed using standard x2 test or Q‐statistic.

Results
: Only three randomized controlled trials (RCT) were identified and included in the review, covering a total of 146 cases. Sample size of all three studies was small. None demonstrated a statistically significant difference in healing rates. Risk differences (RD) of included studies were combined using the inverse variance‐weighted method (pooled RD, ‐6.3%; 95% confidence interval, ‐20.3 to +7.8).

Conclusions: Based on the current best available evidence, single‐visit root canal treatment appears to be slightly more effective than multiple visits, that is, it had a 6.3% higher healing rate. The difference in healing rate between these two treatment regimens was not statistically significant (P= 0.3809), however.
Prevalence and side preference for tooth grinding in twins
Authors: Dooland KV , Townsend GC , Kaidonis JA
Published: March 2008

Background: Estimates of the prevalence of tooth grinding in children range considerably, reflecting different methods of recording. The main aims of this study were to determine the prevalence of tooth grinding in monozygotic (MZ) and dizygotic (DZ) twin pairs by assessing wear faceting on the primary canines, and to compare the faceting on the right and left to determine whether children have a side preference for grinding.

Methods: The sample consisted of 116 MZ twin pairs and 124 dizygous DZ twin pairs, all participants in an ongoing study of dento‐facial development at the dental schools in Adelaide and Melbourne. Evidence of wear faceting on primary maxillary and mandibular canine tips was recorded from dental casts, and the side with the larger wear facet recorded. Types of occlusal relationship, handedness, zygosity and gender were also recorded, and associations between variables analysed statistically.

Results: Canine tip wear facets were found in 100 per cent of the sample, and grinding was lateralized in 59 per cent of children. MZ twin pairs showed a higher discordance for grinding side preference than DZ twin pairs (33.8 per cent compared with 16.8 per cent), providing evidence of a mirror‐imaging effect for grinding side preference. There was no strong evidence that individuals had the same preference for grinding side and handedness, although right‐handers (RH) showed a preference for a grinding side more often than non‐righthanders (NRH) (63.6 per cent compared with 51.2 per cent), consistent with previous findings that RHs display more cerebral lateralization than NRHs.

Conclusions: Tooth grinding appears to be a universal phenomenon in children and is commonly expressed more on one side than the other. The significantly higher discordance for grinding side preference in MZ twin pairs compared with DZ twin pairs may reflect a mirror‐imaging effect in the former. However, at present we have no evidence to suggest that handedness and preferred tooth grinding side are associated.
Maxillofacial trauma in major trauma patients
Authors: Shahim FN , Cameron P. , McNeil JJ
Published: March 2008

Background: Trauma has been identified as a major public health problem in Australia. Maxillofacial trauma constitutes a significant proportion of trauma, although epidemiological studies in Australia are few. The purpose of this study was to assess the prevalence and the epidemiological pattern of maxillofacial trauma occurring in major trauma patients.

Methods: Data were obtained from the Victorian State Trauma Registry, which included all major trauma patients in Victoria. All data relating to maxillofacial trauma defined according to Abbreviated Injury Scale and International Classification of Diseases codes from 1 July 2001 to 30 June 2004 were selected. Data collected included demographic and injury details, and operative procedures carried out.

Results: Sixteen per cent of major trauma patients sustained maxillofacial trauma. The highest frequency of injuries occurred in the 15–24 years age group. More males were affected than females (3:1). The majority of injuries were due to transport‐ related causes (69 per cent) and occurred mostly on roads, streets or highways (70 per cent). Falls were the cause of 15 per cent of injuries, 10.5 per cent of these injuries were fatal while 20.7 per cent needed rehabilitation. The most common type of bony injury was a fractured maxilla.

Conclusion: The need for preventive strategies to be reinforced has been highlighted as transport‐related injuries remain high especially in the younger age groups.
An analysis of complaints against Victorian dental care providers 2000–2004
Authors: Hopcraft M. , Sanduja D.
Published: March 2008

Background: There are little data available on the number and type of complaints made against dental care providers in Australia, despite anecdotal reports of an increasing trend in health‐related complaints and litigation.

Methods: Data were obtained from the Dental Practice Board of Victoria on complaints received between July 2000 and December 2004.

Results: There were 651 complaints against all dental care providers in the study period, which equates to a rate of 4.1 complaints per 100 dental care providers per year. Dentists were responsible for 490 of the complaints, with 66 complaints against dental prosthetists and 43 complaints against dental specialists. There were very few complaints against dental therapists and students, and no complaints against dental hygienists, with 47 complaints against unregistered people or institutions.

Conclusions: This study found that there was a relatively low rate of complaints made against dental care providers in Victoria, with most occurring against dentists in private practice in Melbourne. Less that 10 per cent of complaints resulted in an adverse finding against the dental care provider.
A four‐year retrospective study of adult hospitalization for oral diseases in Western Australia
Authors: Smith K. , Kruger E. , Tennant M.
Published: March 2008

Background: This analysis provides an insight into bed demand for adults for oral health related conditions in Western Australia.

Methods: Data were obtained from the Western Australian Hospital Morbidity Data System for the four financial years 1999–2000 to 2002–2003. This retrospective study analysed the principal diagnosis (ICD‐10AM) obtained for all 53 646 adult patients diagnosed with an oral health related condition. Primary place of residency, gender and Indigenous status were analysed.

Results: More males (52.6 per cent) were hospitalized than females and Indigenous patients were hospitalized 1.5 times more than non‐Indigenous patients. “Caries” were most common in non‐Indigenous patients, with “jaw fractures” most prevalent in Indigenous patients. The majority of patients were hospitalized in a private metropolitan hospital (57.2 per cent). Total costs of hospitalization, both public and private, were in excess of $85 million over four years with $44 million in the public sector.

Conclusions: This study indicates the burden of oral health related conditions on the Western Australian population and the hospital system in terms of health and economical impact.
Orthodontic and prosthetic rehabilitation of unilateral free‐end edentulous space
Authors: Arslan SG , Tacir IH , Kama JD
Published: March 2008

Most patients prefer fixed dentures, even in the presence of uni and bilateral free‐end saddle. The most suitable treatment for this is an implant or implant‐supported prosthetic restoration. A combined prosthetic and orthodontic treatment with distalization of a posterior tooth towards the edentulous region is an alternative approach. This study involved a 34.3 year old female patient who had a free‐end edentulous space on the left mandibula and missing 1st and 3rd molars on the right mandibula. The patient was offered both a removable partial denture and implant treatment options. A detailed explanation of her situation and suitable treatments were given but she refused both options. Therefore, an alternative combined treatment involving prosthodontic and orthodontic disciplines was performed. The second premolar tooth was distalized orthodontically and used as a distal bridge abutment. After 65 months, prosthetic restoration was functional and abutment teeth and periodontium were pathology free, and the patient was satisfied with the results.