The use of radiography and the apex locator in endodontic treatment within the UK: a comparison between endodontic specialists and general dental practitioners

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

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APEXIFICATION WITH BIODENTINE - A CASE REPORT

CODS Journal of Dentistry ◽

10.5005/cods-5-2-3 ◽

2013 ◽

Vol 5 (2) ◽

pp. 3-5

Author(s):

R.S. Bassvanna ◽

Chitra Gohil

Keyword(s):

Case Report ◽

Calcium Hydroxide ◽

Root Canal ◽

Endodontic Treatment ◽

Clinical Scenario ◽

Root Canal Obturation ◽

Single Visit ◽

Dental Practitioners ◽

New Material ◽

Open Apices

ABSTRACT Management of non vital teeth with open apices isa challenge to the dental practitioners. In this clinical scenario, it is difficult to maintain the obturating material confine within the root canal without encroaching into periapical area. These kinds of cases cannot be managed by conventional endodontic treatment, and treatment of such cases with calcium hydroxide may take longer time for apical closure. But with this new material called BIODENTINE (Septodont) same treatment can be done in single visit with predictable result. Hence this case report present the use ofbiodentine to form an apical plug in open apex followed by complete root canal obturation using thermoplasticized guttapercha.

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A protocol for the Development of Core Outcome Sets for Endodontic Treatment modalities (COSET): an international consensus process

10.21203/rs.3.rs-610497/v1 ◽

2021 ◽

Author(s):

Ikhlas El karim ◽

Henry F Duncan ◽

Siobhan Cushley ◽

Venkatesh Nagendrababu ◽

Lise-Lotte Kirkevang ◽

...

Keyword(s):

Clinical Studies ◽

Endodontic Treatment ◽

Treatment Modalities ◽

Core Outcome ◽

Consensus Process ◽

International Consensus ◽

Core Outcome Sets ◽

Key Stakeholders ◽

Dental Practitioners ◽

Patient Reported

Abstract BackgroundThe outcome of endodontic treatment is generally assessed using a range of patient and clinician-centred, non-standardised clinical and radiographic outcome measures. This makes it difficult to synthesise evidence for systematic analysis of the literature and the development of clinical guidelines. Core outcome sets (COS) represent a standardised list of outcomes that should be measured and reported in all clinical studies in a particular field. Recently, clinical researchers and guideline developers have focussed on the need for integration of a patient-reported COS with clinician-centred measures. This study aims to develop a COS that includes both patient reported outcomes and clinician centred measures for various endodontic treatment modalities to be used in clinical research and practice.MethodsTo identify reported outcomes (including when and how they are measured), systematic reviews and their included clinical studies, which focus on the outcome of endodontic treatment and were published between 1990 and 2020 will be screened. The COSs will be defined by a consensus process involving key stakeholders using semi-structured interviews and an online Delphi methodology followed by an interactive virtual consensus meeting. A heterogeneous group of key ‘stakeholders’ including patients, general dental practitioners, endodontists, endodontic teachers, clinical researchers, students and policy-makers will be invited to participate. Patients will establish, via interactive interviews, which outcomes they value and feel should be included in a COS. In the Delphi process, other stakeholders will be asked to prioritise outcomes identified from the literature and patients interviews, and will have the opportunity at the end of the first round to add outcomes that are not included, but which they consider relevant. Feedback will be provided in the second round, when participants will be asked to prioritise the list again. If consensus is reached, the remaining outcomes will be discussed at an online meeting and agreement established via defined consensus rules of outcome inclusion. If consensus is not reached after the second round, a third round will be conducted with feedback, followed by the online meeting. Following identification of a COS, we will proceed to identify how and when these outcomes are measured.DiscussionUsing a rigorous methodology, the proposed consensus process aims to develop a COS for endodontic treatment that will be relevant to stakeholders. The results of the study will be shared with participants and COS users. To increase COS uptake, it will also be actively shared with clinical guideline developers, research funders and the editors of general dental and endodontology journals.Study registrationThe study is registered in COMET (https://comet-initiative.org/Studies/Details/1879)

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The Need for Leadership and Vision in Dentistry. A Personal View

Primary Dental Care ◽

10.1308/135576108784795356 ◽

2008 ◽

Vol os15 (3) ◽

pp. 113-119 ◽

Cited By ~ 4

Author(s):

Vernon P Holt

Keyword(s):

Personal Development ◽

Leadership Skills ◽

Optimal Level ◽

Personal View ◽

Opting Out ◽

The United Kingdom ◽

Dental Practitioners ◽

Dental Profession ◽

New Vision ◽

The Uk

This paper considers how dentistry has developed in the United Kingdom (UK) over the last 60 years and concludes that dentists have failed to be proactive and to shape the systems for the delivery of an optimal level of care to the population. It suggests that there is a need for far better leadership and for dentists, as individuals and as a profession, to rediscover the sense of vision that they once had and to shape their destinies, rather than accepting the current situation. The author goes on to explain how this might be done. Since the inception of the National Health Service (NHS), the dental profession in the UK has, to a large extent, been dominated by the politics of the NHS, by changing fee structures and contracts, by reports from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), and by strategies adopted by successive governments, especially during the last two decades. These strategies have resulted in cohorts of disillusioned dental practitioners reducing their commitment to, or opting out of, NHS contracts and committing themselves, to a greater or lesser extent, to private practice.1 It is now over three years since, for the first time, the proportion of dentistry provided under private contact in the UK, as measured by gross fees, exceeded that provided under NHS contract. The profession has shown a remarkable lack of imagination in organising itself to provide the best kind of care for patients. Instead of being proactive and visionary, it has allowed itself to become a political football. This has led to the progressive deskilling of many practitioners, and a manifest failure to secure the long-term oral health of patients. This paper considers how the situation could be improved and looks at four aspects, which are: 1. 21st century dentistry: state of the art versus reality? The contrast between what is clinically possible and what the profession currently delivers. 2. What are we here for? The need for a new vision for dentistry, the profession and the future, and the need for a new sense of mission. 3. A responsibility for the profession. The responsibility of the profession for providing patients (and funding bodies) with advice. 4. Leading the way: a new-look personal development plan. The personal development needs of dentists, with much more emphasis on interpersonal and leadership skills.

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Post-Endodontic Treatment Flare-Up of Patients Treated By General Dentists and Endodontic Specialists

Open Access Journal of Dental Sciences ◽

10.23880/oajds-16000315 ◽

2021 ◽

Vol 6 (4) ◽

Author(s):

Mohammed Sarhan Alzahrani

Keyword(s):

Postoperative Pain ◽

Statistical Significance ◽

Lesion Size ◽

Endodontic Treatment ◽

Categorical Variables ◽

Preoperative Pain ◽

Patient Factors ◽

Chi Square ◽

Dental Practitioners ◽

General Dentists

Objective: This study aims to determine post-endodontic flare-up incidence for patients treated by endodontic specialists and general dental practitioners. Methods: The investigators measured the postoperative pain using a visual analog scale after 24 and 48 hours for patients treated endodontically by specialists and general dentists. The patient factors and operative variables were documented for every patient. The data was then analyzed using SPSS. A Chi-square test was used to evaluate a relationship between categorical variables, where a P < 0.05 was taken to indicate statistical significance. Results: In total, 143 participants were included in this study (male: n=62, 43.3%; and female: n=81, 56.7%). The incidence of post-endodontic treatment flare-ups was 14.8%. The incidence of 48 hours postoperative pain was higher (29%) with the endodontic specialists compared to the general practitioners. The factors that were associated with a higher postoperative flare-up include; patient age, smoking, preoperative pain, and periapical lesion size. Conclusion: Post-endodontic flare-up incidence in this study was within the reported range of flare-up. Patient factors are associated with the occurrence of the postoperative flare-up more than the operative factors.

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A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control

BDJ ◽

10.1038/sj.bdj.4813028 ◽

2005 ◽

Vol 199 (12) ◽

pp. 784-787 ◽

Cited By ~ 24

Author(s):

I P Corbett ◽

J C Ramacciato ◽

F C Groppo ◽

J G Meechan

Keyword(s):

Local Anaesthetic ◽

Pain Control ◽

Dental Practitioners ◽

The Uk

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Exploring Dentist Opinions on the Provision of Intravenous Sedation in Primary Dental Care for UK Armed Forces Personnel

Military Medicine ◽

10.1093/milmed/usz451 ◽

2019 ◽

Vol 185 (7-8) ◽

pp. e1187-e1192

Author(s):

Dave Edwards ◽

Richard Ramsey ◽

John Breeze ◽

Mark Dermont

Keyword(s):

Dental Care ◽

Dental Treatment ◽

Dental Anxiety ◽

Armed Forces ◽

Operational Experience ◽

Aeromedical Evacuation ◽

Routine Treatment ◽

Dental Practitioners ◽

The Uk ◽

Military Patients

Abstract Introduction: Anxiety toward dental treatment can lead to preventable morbidity, most notably oral pain and infection. This is of concern to the UK Armed Forces (UK AF), as dental care may not be immediately accessible during deployments and exercises, necessitating aeromedical evacuation. Current Defence Policy states that serving UK AF personnel requiring sedation to tolerate routine dental treatment are to have their Joint Medical Employment Standard (JMES) reviewed to restrict their deployability and employability. This article explores current sedation delivery, dentist opinion, and adherence to policy. Materials and Methods: The total number and type of intravenous (IV) sedation appointments over a 6-month period was assessed using surgical logbooks. Questionnaires were sent to all dentists in primary care responsible for treating military patients to ascertain their attitudes toward the requirement for sedation in support of recruitment and deployability. Ten-year retrospective data analyses were used to identify current trends in sedation use in the UK AF. Results: Responses were received from 117/137 (85%) dentists. All of the responding Civilian Dental Practitioners felt that there was a requirement for IV sedation in contrast to the Royal Navy (RN), where over a quarter (28%) disagreed. The majority, 48 (81%), of Army dentists felt that military patients unable to tolerate routine treatment under local anesthesia alone should not deploy on operations, compared with 7 (63%) of their civilian counterparts. Overall, 72 (62%) respondents felt that patients unable to tolerate routine treatment without sedation should not be recruited. Conclusions: Civilian Dental Practitioners in the sample indicated that they were less likely to recommend a patient for JMES review, less likely to prevent patients from deploying and less likely to believe that individuals requiring sedation for routine treatment should not be recruited into the UK AF. These attitudes are contrary to current Defence direction and could increase the risk of UK AF personnel experiencing morbidity on deployment requiring aeromedical evacuation. Over the longer term, civilianization of Defence dentistry is likely to reduce collective operational experience and Defence must ensure that clinicians understand the management of anxious patients in the military context and their responsibilities in relation to JMES. Furthermore, policy limiting the recruitment of personnel with significant dental anxiety is not being robustly adhered to. Based on the number of dental procedures undertaken under IV sedation in the UK AF, consistent application of this policy would not affect recruitment at an organizational level, but would limit the risk of deploying these personnel. Further work is required to understand dental anxiety within the UK Armed Forces so that the operational morbidity risks can be quantified and provision appropriately planned.

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Opinions and attitudes of endodontists and general dental practitioners in the UK towards the intra-canal fracture of endodontic instruments. Part 2

International Endodontic Journal ◽

10.1111/j.1365-2591.2008.01473.x ◽

2008 ◽

Vol 41 (12) ◽

pp. 1079-1087 ◽

Cited By ~ 22

Author(s):

A. A. Madarati ◽

D. C. Watts ◽

A. J. E. Qualtrough

Keyword(s):

Dental Practitioners ◽

The Uk

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Current Trends in Endodontic Treatment by General Dental Practitioners: Report of a United States National Survey

Journal of Endodontics ◽

10.1016/j.joen.2014.01.029 ◽

2014 ◽

Vol 40 (5) ◽

pp. 618-624 ◽

Cited By ~ 37

Author(s):

Gina M. Savani ◽

Wael Sabbah ◽

Christine M. Sedgley ◽

Brian Whitten

Keyword(s):

United States ◽

National Survey ◽

Endodontic Treatment ◽

Current Trends ◽

Dental Practitioners

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Management of patients on oral anticoagulants in dental practice

Dental Update ◽

10.12968/denu.2020.47.11.912 ◽

2020 ◽

Vol 47 (11) ◽

pp. 912-922

Author(s):

Shrina Nathwani

Keyword(s):

Best Practice ◽

Dental Treatment ◽

Oral Anticoagulants ◽

Quality Care ◽

Current Evidence ◽

Ageing Population ◽

Oral Surgical Procedures ◽

Dental Patients ◽

Dental Practitioners ◽

The Uk

The UK has an increasingly ageing population and, inevitably, the prevalence of anticoagulation among dental patients will grow. This same group of patients are retaining their natural teeth longer and will potentially require dental treatment and oral surgical procedures and so, general dental practitioners will need to be aware of the implications of anticoagulant drugs. Equally, to comply with requirements set by the General Dental Council's ‘Standards for the Dental Team’ it is imperative to ensure that, as clinicians, we put patients' interests first, and provide quality care based on current evidence. CPD/Clinical Relevance: It is important that dentists have knowledge and expertise to consult and treat medically compromised patients for patient safety and to adhere to best practice guidelines.

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