Simon James Stone

Objectives: Lack of regular access to dental services for children can increase disease prevalence and burden on NHS services, which is aggravated for the most vulnerable. Non‐clinical community hubs could be a feasible alternative for dental checks and oral health education. The aim of this study was to assess the oral health of children attending a non‐clinical community hub, and the feasibility/acceptability of these settings to children. Method: This study adopted an parallel mixed‐methods approach. Dental screening of children (0–16 years old) was undertaken in a non‐clinical community hub by a trained and calibrated dentist in April 2024. Basic demographics, global quality of life and clinical data were collected. All children were given oral health education using tooth models and dietary advice. A sub‐sample of children were recruited for qualitative inquiry, using a purposive sampling strategy. Three focus groups were facilitated with a pre‐determined topic guide and creative arts‐based techniques to facilitate discussion. These were audio‐recorded, transcribed verbatim and inductively coded following thematic analysis. Results: Over the 5‐day period, 141 children were screened with a mean age of 6.4 years (SD 3.8). Mean d ₃ mft was 1.7 (SD 2.9; 0–15), D ₃ MFT was 0.3 (SD 0.9; 0–4), and combined d ₃ mft/D ₃ MFT was 2.0 (SD 3.1; 0–19). Fifteen patients had silver diamine fluoride, 125 had fluoride varnish and one refused. Forty‐one children were signposted for future care. Three focus groups involving 11 children identified three themes that were constructed from the data were: ‘space’ requirements; promoting positive engagement; familiarity with the environment. Children were generally accepting of foodbanks as settings for oral health screening and preventive care. They emphasised the importance of child‐friendly, non‐threatening spaces and highlighted how familiar environments and trusted staff fostered feelings of safety and engagement. Conclusion: Non‐clinical community hubs are feasible and acceptable spaces to children to screen for oral health, providing a unique opportunity to reduce barriers to access and to target underserved groups with following on screening activities.

Objectives: High-speed dental instruments produce aerosol and droplets. The objective of this study was to evaluate aerosol and droplet production from a novel electric micromotor handpiece (without compressed air coolant) in real world clinical settings. Methods: 10-minute upper incisor crown preparations were performed in triplicate in an open-plan clinic with mechanical ventilation providing 3.45 air changes per hour. A 1:5 ratio electric micromotor handpiece which allows water coolant without compressed air (Ti-Max Z95L, NSK) was used at three speeds: 60,000 (60K), 120,000 (120K), and 200,000 (200K) revolutions per minute. Coolant solutions contained fluorescein sodium as a tracer (2.65 mmol L−1). High-speed air-turbine positive control, and negative control conditions were conducted. Aerosol production was evaluated at 3 locations (0.5 m, 1.5 m and 1.7 m) using: (1) an optical particle counter (OPC; 3016-IAQ, Lighthouse) to detect all aerosol; and (2) a liquid cyclone air sampler (BioSampler, SKC Ltd.) to detect aerosolised fluorescein, which was quantified by spectrofluorometric analysis. Settled droplets were detected by spectrofluorometric analysis of filter papers placed onto a rig across the open-plan clinic.Results: Local (within treatment bay) settled droplet contamination was elevated above negative control for all conditions, with no difference between conditions. Settled droplet contamination was not detected above negative controls outside the treatment bay for any condition. Aerosol detection at 1.5 m and 1.7 m, was only increased for the air-turbine positive control condition. At 0.5 m, aerosol levels were highly elevated for the air-turbine, minimally elevated for 200K and 120K, and not elevated for 60K. Conclusions: Electric micromotor handpieces which use water-jet coolant alone without compressed air, produce localised (within treatment bay) droplet contamination but are unlikely to produce aerosol contamination beyond the immediate treatment area (1.5 m), allowing them to be used safely in most open-plan clinic settings.

Objective To investigate current strategies of acute management of irreversible pulpitis by general dental practitioners. Design A postal survey was sent to a representative sample based on postal code to 180 dentists registered with the General Dental Council in the North East of England. The questionnaire identified general dental practitioners' strategies for the diagnosis and acute management of irreversible pulpitis. Results One hundred and three questionnaires were returned. Irreversible pulpitis was primarily diagnosed from patients' signs and symptoms. There was a high confidence in anaesthetising a tooth with irreversible pulpitis. Treatment was undertaken with either pulpotomy (with a view to single or multi-stage orthograde root canal treatment) or full extirpation in just over half of respondents (51%). Seventy-one percent of respondents reported using different intrapulpal medicaments. Antibiotics were 'frequently' prescribed in cases of irreversible pulpitis by 25% of respondents. For endodontic procedures, dental dam usage was generally low and used 'occasionally' or 'never' by 40% of respondents. Conclusions Antibiotics were being inappropriately prescribed in the management of irreversible pulpitis, transgressing from NICE guidelines on antibiotic usage. Rubber dam use is not universal during the initial management of pulpitis, or during the definitive endodontic procedure, impacting upon the safety and predicility of outcome. Respondents often placed medicaments into the pulp, in spite of a lack of evidence for their efficacy.

Background: This study uses multiple, contemporary methodologies to expand our knowledge of the temporal relationship between host‐microbial interactions and clinical signs of gingivitis.Methods: Subgingival plaque and crevicular fluid samples were collected from 31 systemically healthy adults with naturally occurring plaque‐induced gingivitis. Professional prophylaxis was administered and participants were followed over 7 weeks. Microbial characterization was performed using a bead‐based hybridization assay and cytokine analysis using bead‐based flow cytometry.Results: The provision of sequential interventions, oral hygiene instruction, and subsequent professional prophylaxis brought about significant reduction of plaque and resolution of gingivitis at all post baseline time points (P < 0.0001). Candidate cytokines that increased significantly (95% level) were interleukin (IL)‐1β, matrix metalloproteinases (MMP)‐1, MMP‐3, MMP‐8, MMP‐9, from baseline to week 2; regulated on activation, normal T cell expressed and secreted (RANTES) at week 4 and week 8; macrophage inflammatory protein (MIP)‐1α and MIP‐1β at week 8. Resolution of inflammation was accompanied by a shift in the microbiological flora toward those species associated with health.Conclusions: This study provides further evidence of the dynamic relationships that exist between the overt clinical signs, the microbial biofilm, and the host response in gingivitis and upon resolution following clinical interventions. Understanding the interactions between the host immune system and subgingival microbial communities during the resolution of established gingivitis continues to evolve as additional knowledge is achieved through using new analytical technologies. The present study confirms a critical effect of oral hygiene measures on restoration of microbial eubiosis in subgingival communities, confirming the important role for home care and professional intervention in maintaining oral health.

Background: The increasingly competitive global higher education sector recognises the impact of teaching quality and a strong student voice. This means that student satisfaction is under increasing scrutiny; however, little is known about how clinical teachers actually teach. At present, the relationship between actual patterns of individual dental student‐clinician interaction and student satisfaction is unclear.Aim: To investigate the relationship between patterns of verbal interaction and individual student satisfaction, during dental clinical teaching encounters.Methods: A total of 150 patterns of verbal interactions between Stage 2 (BDS and Hygiene and Therapy, n = 86) students and clinical teaching staff were recorded within a clinical skills environment in a Dental School in the United Kingdom. Verbal interaction analysis (VIA) was used as a basis for recording full verbal interactions between students and skills teachers.Results: The length of the encounter, the amount of praise/encouragement, the level of criticism, the number of questions asked and the proportion of student talk were significant predictors of student satisfaction. The proportions of time spent with the teacher talking, time spent in silence and time spent examining the patient or clinical work were not significant predictors of student satisfaction. Further, the degree to which the teacher lectured or gave direction was not a significant predictor of student satisfaction.Conclusions: A number of observed behaviours correlated significantly with increased satisfaction. Praise and the acceptance of student ideas are required to offset high levels of criticism, and the encounter seems to require structure from the clinician with an emphasis on indirect influence rather than just lecturing.

Aim: To develop and preliminarily evaluate a new screening instrument for atypical odontalgia (AO) or persistent dentoalveolar pain disorder (PDAP). To evaluate the instrument's performance in detecting AO/PDAP amongst a heterogeneous group of orofacial pain conditions and pain‐free controls and empirically compare its performance with an established neuropathic screening instrument (S‐LANSS), which is the best available standard.Methods: The study design was cross‐sectional; subjects recruited included a convenience sample of pain‐free controls (n = 21) and four groups of orofacial pain conditions: AO/PDAP (n = 22); trigeminal neuralgia (n = 21); temporomandibular disorder (n = 41); and acute dental pain (n = 41). The instrument's internal reliability and factor structure were examined alongside its sensitivity and specificity and ROC‐determined threshold score.Results: The 9 AO/PDAP‐specific items were found to moderately correlate with the S‐LANSS (r = 0.58; P < 0.01). The 14‐items of the full instrument were examined using exploratory factor analysis and reduced to ten items in a two‐factor structure that explained 96% of the variance. This 10‐item final instrument had a ROC area of 0.77 (95% CI: 0.67; 0.88), sensitivity of 77% (95% CI: 55; 92%), and specificity of 69% (95% CI: 60; 77%) with an intentionally higher false‐positive rate than false‐negative rate. In contrast, the S‐LANSS exhibited sensitivity of 32% (95% CI: 14;55%) and specificity of 78% (95% CI: 70;85%) with less optimal false‐positive versus false‐negative rates.Conclusion: This preliminary study confirms the new screening instrument for AO/PDAP merits progression to field testing.