Aim To assess the impact of initial correction of Class II division I malocclusion (II/1M) with a Modified Twin Block (MTB) appliance on children and their parents compared to untreated children with II/1M and their parents. Methods Sixty participants with II/1M received MTB treatment and 47 participants with II/1M served as controls. At baseline (T1) and following MTB treatment or recall (T2), all assessed Oral Health Related Quality of Life (OHRQoL), self-esteem and rated perceived aesthetic component of orthodontic treatment need (AC-IOTN). At T1 and T2, a 3D facial soft tissue image was captured at rest. Similarly, at T1 and T2, a parent assessed their child’s OHRQoL and perception of AC-IOTN. Appropriate statistical comparisons were made between and within groups. Results MTB treatment was completed by 42 participants; 35 controls were recalled. At T1, groups were similar in age and gender (p>0.05), mean overjet was 1 mm greater in the MTB group (p<0.01). At T2 in the MTB group, child reported OHRQoL, self-perception of AC-IOTN, and parent-perception of their child’s OHRQoL and AC-IOTN improved as did Family Quality of Life (QoL) (p<0.001); self-esteem remained unchanged. At T1 and T2 for both groups, parents rated their child’s OHRQoL poorer than the child. From T1 to T2, soft tissue changes in both groups and inter-group differences were modest (p<0.05). Conclusion MTB treatment positively impacted child OHRQoL, Family QoL and child and parent perception of AC-IOTN but did not impact child self-esteem. 3D facial soft tissue changes were modest. Child and parent perception of OHRQoL and AC-IOTN were discordant.
Introduction Little is known about the oral health of older adults in nursing homes in Ireland. This study explored the use of the Modified Oral Status Survey Tool (MOSST) in examining the oral health of this population. Objectives 1. Trial the use of the MOSST by a dentist in the nursing home population in Ireland. 2. Provide initial data on the oral health status of participants. 3. Provide initial data on dental service use and oral health-related quality of life (OHRQOL). Methods Training and calibration in the MOSST and its accompanying questionnaire were completed and ethical approval gained. Convenience sampling from private nursing homes in Leinster was undertaken. Patients aged 65+ who were able to provide informed consent were eligible for inclusion. Results Five nursing homes were visited, which housed 366 residents. Of these, 78 people were willing to be examined and able to consent to examination. No participants were identified as having urgent dental needs. Despite the variety in numbers of functional units, natural teeth and visibly cavitated teeth, the majority of participants did not report pain or difficulty chewing, and were happy with their smile. Conclusion The low number of participants illustrates the difficulty of research in the nursing home population. Large numbers of people were not able to provide informed consent, largely due to barriers such as dementia. However, the MOSST was easy to use in the population able to consent, and beneficial in that it can be used by both dentists and non-dentists following training.
Objectives To describe the oral health status of a sample of older adults residing in nursing homes in Northern Ireland (NI). A secondary objective was to explore associations between a number of oral health parameters and cognitive impairment for a subgroup of the study population. Background Care home residents are frequently excluded from national oral health surveys, resulting in limited epidemiological data to inform service planning. The population of Northern Ireland is ageing, and life expectancy is increasing. With older people now retaining their natural teeth into older age service providers and policymakers should be aware of the oral health status of this population group. Methods A retrospective epidemiological analysis of oral health assessment records collected between 31 January 2019 and 31 January 2020 across two Health and Social Care (HSC) Trusts within Northern Ireland was undertaken. Results Data were available for 1,477 residents (mean age 83.1 years; 67.1% female). Overall, 67.3% were dentate. Among dentate residents, 29.0% had active carious lesions and 35.8% of all residents had retained roots in situ. Poor oral hygiene was recorded in 56.3% of dentate residents. Increasing age was significantly associated with reduced odds of being dentate (OR 0.73 per 10-year increase; p=0.017). In the cognitive impairment subgroup (n=381), no significant associations were observed between cognitive status and caries, retained roots, or number of teeth. The only variable positively associated with cognitive impairment in multivariate analysis was the number of fractured teeth (OR 0.55; p=0.026). Conclusions A high burden of untreated dental disease exists among nursing home residents in Northern Ireland. The majority have retained natural teeth, thus increasing their preventive and restorative care needs. Strategic workforce planning, preventive programmes, and enhanced access to dental services are required to address unmet need in this vulnerable care dependent population.
Aim: This Clinical Feature discusses current non-surgical treatments for peri-implantitis, focusing on their efficacy, limitations, and possible adjunctive strategies for optimising non-invasive management. Background: Peri-implantitis is a biofilm-induced inflammatory condition causing progressive bone loss. Mechanical decontamination remains the mainstay of non-surgical therapy, sometimes combined with antimicrobials and chemical agents. Findings: Non-surgical therapy reduces probing depths and bleeding on probing but rarely achieves full resolution of the disease. Low-abrasive air powders (glycine, erythritol) and novel systems like electrolysis, improve biofilm removal with minimal surface damage. Chemical and systemic adjuncts show limited, short-term benefits. Supportive maintenance and strict plaque control are essential for the long-term success of the non-surgical treatment. Conclusions: Non-surgical therapy can stabilise peri-implantitis and delay surgery when combined with maintenance care. Future management is shifting toward minimally invasive, regenerative, and technology-enhanced approaches to improve predictability and tissue preservation.
Introduction There exists an abundance of published literature highlighting the problems associated with the retention of asymptomatic, partially erupted third molars, in particular the mandibular mesioangular third molar. The issues surrounding rigid adherence to the 2000 UK National Institute for Health and Care Excellence (NICE) guidance are well documented, and it is no surprise that its place in modern oral surgery practice has been called into question. This shi away from the old status quo has led to confusion among general dental practitioners (GDPs) about the appropriate timing of wisdom tooth referrals, and indeed whether to refer patients in the first place.
Ectodermal Dysplasia (ED) is a hereditary disorder that is caused by dysplasia of one or more of the ectodermal tissues, with hypodontia or anodontia being common. Prosthetic rehabilitation is a routine process for people with ED from childhood to adulthood. This paper presents a case of the multidisciplinary team (MDT) management of a 36-year-old female patient with anhidrotic ED, a hypoplastic maxilla and hypodontia and with skeletal and dental concerns. The MDT included Consultants in Oral and Maxillofacial Surgery, Restorative Dentistry and Orthodontics. Following CBCT imaging and digital MDT planning, treatment involved a two-step surgical approach with a bimaxillary osteotomy and bone grafting, followed by delayed insertion of transzygomatic and conventional dental implants. These were restored with a full arch maxillary bridge and a lower implant retained complete denture. The piezoelectric system was used as part of the surgical procedure to ensure the optimal patient outcome was achieved. Follow up radiographic and clinical evaluation revealed appropriate healing, an enhanced facial profile and a stable and functional occlusion. The patient is very satisfied and her skeletal and dental concerns have been successfully addressed. The integration of two-stage orthognathic surgery and digital MDT planning allowed for the restorative rehabilitation of a person with ED, a hypoplastic maxilla and hypodontia. This case demonstrates the favourable use of piezoelectric saws in the osteotomy of an underdeveloped maxilla as well as outlining the need for MDT planning to ensure the optimal outcome for patients with ED. Précis: This case report highlights how a two-stage surgical approach and digital Multidisciplinary Team planning allowed for successful restorative rehabilitation of a patient with Ectodermal Dysplasia.
This short clinical article provides general dental practitioners [GDPs] with an overview of some the clinical and planning challenges that frequently arise in the provision of clear aligner treatment. The article provides an overview of the benefits of a new way of working, in which the GDP is supported and mentored through the key stages of treatment offering the following advantages: better case selection; more predictable treatment plans and gaining valid consent. All of which aim to optimise the GDP and more importantly patient experience and outcome.
Oral cancer and its treatment present complex restorative and prosthetic challenges that significantly impact patients’ function, aesthetics, and quality of life. This narrative review summarises the key post-treatment complications including trismus, hyposalivation, radiation caries, mucositis, osteoradionecrosis, and altered oral anatomy; and evaluates their implications for dental rehabilitation. Surgical resections, radiotherapy, and chemotherapy collectively lead to anatomical changes, compromised salivary function, and tissue fragility, complicating prosthesis fabrication, retention, and patient adaptation. These complications impact key aspects of prosthetic care such as impression-making, jaw registration, prosthesis stability, retention, and patient adaptation. By outlining the clinical implications of these complications, this review highlights the need for careful assessment and an individualised, multidisciplinary approach when planning restorative and prosthetic treatment for oral cancer patients Key words – Oral cancer, Prosthetic Rehabilitation, Restorative Challenges
Tooth wear is increasingly prevalent globally and presents diagnostic and treatment challenges that require the development of standardised indices for monitoring and timing intervention. Tooth wear is becoming more common among younger cohorts and is not entirely dependent on age, but is influenced by factors including diet and lifestyle. Given its multifactorial nature, pinpointing a single causative factor is challenging. Nevertheless, it is crucial to establish systems and indices for monitoring the progression of tooth wear, enabling timely intervention. This review aimed to determine which tooth wear index could be recommended for use in general dental practice and within different settings. The literature was investigated for the most used tooth wear indices since 2017 through databases of international journals (PUBMED, Google Scholar, and ScienceDirect). Once the field of articles was narrowed, it allowed a concise number of indices to be accounted for. A total of 758 papers were retrieved from the search engines after using pre-specified search matrices. These papers were filtered by two independent reviewers, leaving 39 papers that fit the eligibility criteria. Information regarding index used, design/settings of the study, country, sample size, age, and outcomes were extracted from these papers to synthesise the evidence. This review revealed a multitude of indices proposed for the classification and recording of tooth wear in the general population. However, none of these indices fully embody the ideal characteristics of being both user friendly and capable of providing all-inclusive information.
The General Dental Council’s Safe Practitioner framework of behaviours and outcomes for dental professional education outline the need for dental undergraduates to learn evidence-based approaches to clinical practice. The Dental RECUR Brief Negotiated Interview (DR-BNI) is an effective oral health behaviour change intervention that draws upon psychological frameworks of disease prevention, behaviour change science, and patient-facing communication skills. Training in this approach involves developing participants’ knowledge of childhood caries, and confidence applying personalised preventive advice to clinical practice via supervised role-play. This study explored the effectiveness of a DR-BNI training workshop on developing dental undergraduates’ behaviour change conversation knowledge and confidence. Seventeen participants completed a pre-post evaluation which assessed their knowledge of DR-BNI-related topics and confidence in applying relevant skills to clinical practice. Participants’ knowledge of all topics including the development of dental caries in children, motivational interviewing, and behaviour change theory significantly increased following the workshop. Participants’ confidence in applying skills for delivering a behaviour chance conversation with a dental patient also significantly increased. The DR-BNI represents a useful model for developing dental undergraduates’ behaviour change conversation knowledge and confidence.
Intrabony defects pose a significant clinical challenge due to their association with progressive periodontal destruction, leading to compromised tooth prognosis. Traditionally, regenerative surgical approaches have been employed to restore lost periodontal structures; however, there is growing interest in minimally invasive non-surgical therapy (MINST) as an alternative. MINST is a precision-driven, conservative approach that preserves the integrity of the soft tissue while promoting periodontal regeneration. The core principles of MINST involve the use of magnification, piezoelectric ultrasonics, and fine-tipped curettes to ensure thorough root debridement with minimal trauma. By avoiding flap elevation, MINST aims to maintain a stable blood clot within the defect, leveraging the body’s natural healing potential. Clinical studies have demonstrated that MINST effectively reduces probing pocket depths (PPD) and improves clinical attachment levels (CAL) with minimal soft tissue recession. Long-term follow-up data suggest comparable outcomes to surgical regenerative techniques. However, the absence of histological confirmation of true periodontal regeneration remains a limitation. This clinical feature explores the biological principles underlying MINST, its clinical effectiveness, and its potential role as a viable alternative to surgery in the management of intrabony defects.
Understanding how students approach learning is of interest in health professional education, though there is limited evidence that identifying learning styles improves educational outcomes. This study investigated learning style preferences of clinical dental students at Queen’s University, Belfast, using the VARK questionnaire, and explored whether preferences were associated with gender or academic achievement. Of 86 respondents (72% response rate), 69% preferred multimodal learning styles, with quad-modal (all four VARK modes) being the most common at 41%. Multimodal refers to a preference for more than one learning style. No relationship was found between learning style, gender, or academic distinction. Notably, a higher proportion of females achieved distinctions, a finding warranting further exploration. These results suggest that while multimodal learning is common, learning style preferences do not explain gender differences in academic performance. Given the lack of evidence for the efficacy of adapting teaching to learning styles, caution is warranted in using this information to inform curriculum design.
Potential associations between periodontitis and a range of systemic conditions, including coronary heart disease, diabetes and respiratory disease, have been widely reported. This review evaluates the evidence for a similar link between periodontitis and the outcomes of COVID-19 infection during the recent pandemic, alongside potential biological mechanisms underlying such an association. The evidence available to date, while limited, does tend to support an association, with periodontitis patients being at increased risk of developing adverse outcomes, including the need for assisted ventilation, ICU admission and death. A range of factors have been suggested to explain such an association both locally within the periodontal pocket and more systemically through bacteraemia and increased levels of systemic inflammation. This apparent association between periodontitis and adverse COVID-19 outcomes further highlights the importance of improving and maintaining periodontal health in our population.
The primary goal of endodontic intervention is to attain and preserve the health of the periapical tissues. Outcome measures have been incorporated into endodontics for decades to analyse whether this objective has been achieved, thereby documenting treatment effectiveness, evaluating patient care, and facilitating decision-making. The upsurge of evidence-based, patient-focused practices in endodontics has resulted in a shift in how we define the success of treatment. The importance of patient-reported measures has become more apparent in recent years, with the inclusion of PROs in outcome reporting. However, there remains a lack of consensus on a unifying criterion for endodontic outcomes, with clinicians, researchers, and patients all contributing differing ideas of what constitutes success. The goal of this review is to explore the current use of PROs in endodontology, establish the potential value of including these measures in future endodontic care and research and to examine the necessary prerequisites for their adoption into a core outcome set for endodontics.
This case report discusses a rare and severe complication arising from endodontic treatment, specifically overfilling and extrusion of root canal sealer into the mandibular canal, leading to injury of the Inferior Alveolar Nerve (IAN). A 42-year-old female presented with severe pain and complete paraesthesia in the lower lip and chin area ten (10)days after endodontic treatment. Radiographic examinations revealed left overfilled root canals extending approximately five (5) centimetres along the mandibular canal. A unilateral sagittal split osteotomy was performed using piezosurgery to protect the nerve. Meticulous dissection was performed to release it from the canal. Notably, rigid paste debris was observed in proximity to and within the nerve canal. The nerve exhibited signs of swelling and was enveloped by granulation tissue. A thorough cleaning procedure ensued, followed by the repositioning of the two mandibular cortices, securing them in place with AO 5.0-mm diameter bicortical screws. Orthodontic brackets were used to stabilize the occlusion for six (6) weeks. Two weeks after the surgery, the patient reported that the pain had significantly improved, with only a tingling sensation remaining. The feeling of pressure was completely relieved. At one year follow-up, the sensation was partially restored and no pain was reported. This case underscores the potential for serious complications arising from endodontic treatments and highlights the efficacy of surgical exploration, particularly through sagittal osteotomy, in addressing nerve injuries caused by overfilled root canals.
Innovations in the digital workflow are providing clinicians with indispensable tools for accurately manifesting planned surgical outcomes into clinical realities, with precise and predictable results beyond what free-hand techniques can offer. This clinical tip guide aims to illustrate how contemporary digital tools may be used to plan and implement facially-driven and digitally-guided surgical crown lengthening with a view towards addressing an uneven gingival display within a smile, with a high degree of clinical control.
Classic approaches to prosthodontic treatment are evolving in the era of digital dentistry; where higher levels of control and precision may be efficiently achieved as they relate to the development of treatment outcomes that are important to patients. The application of tooth reduction guides, developed on the basis of a facially-driven digital smile design, assist clinicians in achieving highly refined outcomes, whilst minimising the biological cost of indirect dentistry.
Sustainable procurement in dentistry means choosing products and suppliers in such a way as to minimise environmental impacts without compromising patient safety. In the UK, NHS dental procurement has been shown to account for 18% of the carbon footprint of dentistry.1 Sustainable procurement can lead to lower operational costs because of reduced waste and increased efficiency. Other benefits to the practice include enhanced patient recognition, as patients are increasingly environmentally aware. Dental suppliers will benefit from selling safer products and can use this more sustainable approach to promote their business. Sustainable procurement in dentistry should be viewed as a practice-level initiative that links into a broader regional/national health system strategy to reduce greenhouse gas (GHG) emissions (50% reductions required for the Irish public sector by 2030).2 Embedding dental procurement within these frameworks ensures consistency with the wider EU Green Deal and national decarbonisation targets.3 Procurement decisions can be evaluated in different ways. The four pillars of sustainability are social, human (including healthcare), environmental, and economic. These factors must prosper in a balanced way for a sustainable future. To that end, the triple bottom line theory is a sustainability framework used in business that measures a business’s success across three parameters: its social impact (people); its environmental impact (planet); and, its financial performance (profit). This guides the procurer to pre-assess purchases not only for monetary value but to minimise carbon and waste, to ensure ethical labour practices in supply chains, protect staff and patient health by reducing chemical exposure, and deliver best value when life cycle costs (LCCs) are considered. The reader may have seen a recent paper by one of the authors demonstrating that manufacturing toothbrushes locally, or at least within Europe, has more positive social outcomes across several levels; this also applies to other procurement products.
The aim of this article is to provide the clinican with some tips for effective shade selection & communication to the dental laboratory.
Correction of anterior or posterior crossbite may be undertaken by removable appliances in the mixed dentition. The Dental Council of Ireland requires a graduating dentist to be able to design, insert and adjust active removable appliances to manage simple malocclusions. This requirement is aligned with the recommended outcomes established by the Graduating European Dentist (GED) resource of the Association for Dental Education in Europe (ADEE) which have been adopted by the Dental Council. This paper describes a typodont model to assist in teaching design, insertion and adjustment of two upper removable appliances, one for correction of a single tooth anterior crossbite and the other for correction of a posterior crossbite, both amenable to interception in the mixed dentition.
