Light-curing units used in dentistry: factors associated with heat development – potential risk for patients

Source: doi: 10.1007/s00784-016-1962-5Objectives:To investigate how heat development in the pulp chamber and coronal surface of natural teeth with and without cusps subjected to irradiance using light-emitting diode (LED)–light-curing units (LCUs) is associated with (i) irradiance, (ii) time, (iii) distance, and (iv) radiant exposure. Materials and methods:Three different LED-LCUs were used. Their irradiance was measured with a calibrated spectrometer (BlueLight Analytics Inc., Halifax, Canada). An experimental rig was constructed to control the thermal environment of the teeth. The LED-LCU tip position was accurately controlled by a gantry system. Tooth surface temperature was measured by thermography (ThermaCAM S65 HS, FLIR Systems, Wilsonville, USA) and pulp chamber temperature with a thermocouple. LED-LCU tip distance and irradiation times tested were 0, 2, and 4 mm and 10, 20, and 30 s, respectively. Ethical permission was not required for the use of extracted teeth. Results:Maximum surface and pulp chamber temperatures were recorded in tooth without cusps (58.1 °C ± 0.9 °C and 43.1 °C ± 0.9 °C, respectively). Radiant exposure explained the largest amount of variance in temperature, being more affected by time than irradiance. Conclusions:At all combinations of variables tested, repeated measurements produced consistent results indicating the reliability of the method used. Increased exposure time seems to be the factor most likely to cause tissue damage. Clinical relevance:Risk of superficial tissue damage at irradiances >1200 mW/cm2 is evident. There is a risk of pulp damage when only thin dentin is left at higher irradiances (>1200 mW/cm2). Clinicians should be aware of LED-LCU settings and possible high temperature generated

How does indirect air-cooling influence pulp chamber temperature in different volume teeth and absence/presence of resin-based composite during light curing?

Background Light-curing of materials during restorative dental procedures poses a risk for pulp tissue overheating. Therefore, the aim of this study was to investigate the effect of indirect air-cooling on pulp chamber temperatures during light-curing of varying volume teeth and absence/presence of resin-based composite (RBC) at different exposure time. Methods The volume of 11 human teeth was measured by micro computed tomograph. An experimental rig controlled the thermal environment of the teeth and a thermocouple inserted retrograde into the root canal measured temperature changes. Pulp chamber temperature was measured with and without air-cooling on teeth without and with RBC at 15 s, 30 s and 60 s intervals. Generalized estimating equations were used for statistical analysis. Results The temperature increase with air-cooling (versus no air-cooling) was lower in teeth despite absence/presence of RBC (β = − 4.26, 95%CI − 5.33 and β = − 4.47, 95%CI − 5.60, respectively). With air-cooling, the temperature increase in teeth with RBC was lower compared to teeth without RBC (β = − 0.42, 95%CI -0.79; − 0.05). Higher teeth volume resulted in lower temperature increase with air-cooling than without air-cooling (β = − 0.04, 95%CI -0.07; − 0.01 and β = − 0.17, 95%CI -0.30; − 0.05, respectively). Conclusions Air-cooling resulted in lower pulp chamber temperature increase. Using air-cooling, the temperature increase was lower in teeth with RBC compared to teeth without RBC. Lower volume teeth resulted in higher temperature increase, thus they seemed to benefit more from air-cooling compared to higher volume teeth. Air-cooling could be an effective tool in controlling pulp temperature increase during light-curing, especially when the tooth volume is small

The educational gradient in dental caries experience in Northern- Norway: a cross-sectional study from the seventh survey of the Tromsø study

Background Although, studies from Norway indicate a reduction in dental caries experience, in Northern-Norway this non-communicable oral condition is still prevalent. There is conflicting evidence of presence of social inequalities in dental caries in an adult population. Therefore, the aim of this study was to assess an association between educational level and dental caries experience in adults in urban Tromsø municipality, Northern-Norway, using The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) framework of health determinants. Methods Data from 3752 participants having recorded dental caries status and educational level in the seventh survey of the Tromsø Study: Tromsø7 were included. Dental status was examined clinically as decayed-, missing-, filled-teeth (DMFT score). For statistical analyses DMFT score was grouped into lower (DMFT<19) and higher (DMFT≥20). Educational level was obtained from a questionnaire and categorized as primary/partly secondary education, upper secondary education, tertiary education, short and tertiary education, long. Data on social and intermediary determinants was also self-reported. Univariable and multivariable binary logistic regression analyses were applied. Result This study included 1939 (52%) women and the mean age of the participants was 57.11. The mean DMFT score was 18.03. The odds of having higher DMFT score followed a gradient based on educational level. Participants who reported lower than secondary education had 2.06 -fold increased odds of having higher DMFT score than those with tertiary education, long (OR: 2.06, 95% CI: 1.50–2.83). Those with upper secondary education had 60% higher odds of having higher DMFT score (OR: 1.60, 95% CI: 1.21–2.11), and those with tertiary education, short had 66% higher odds of having higher DMFT score (OR: 1.66, 95% CI: 1.24–2.22). Conclusion The current cross-sectional study suggested an educational gradient in dental caries experience in an adult population of Northern- Norway. Further studies validating our results and investigating mechanisms of educational inequalities in oral health are warranted

Changes in management preference of deep carious lesions and exposed pulps: questionnaire studies with a 10-year interval among dentists in Lithuania

We aimed to investigate changes in management preferences for deep carious lesions and pulps exposed during carious tissue removal that occurred during the last 10 years and identify associated dentists’ background factors. The data were collected among dentists registered with the Lithuanian Dental Chamber at two time points using a similar questionnaire. In 2011, 400 randomly selected dentists received a questionnaire by mail, and 153 (38.3%) responded. In 2021, an electronic invitation to an online questionnaire was sent to all members of the Lithuanian Dental Chamber, and 213 (8.9%) dentists responded. The questionnaire included the definitions of management options, a radiograph, and a clinical picture of a deep carious lesion reaching to the inner fourth of dentine in a mature permanent tooth, asked management preferences in four different scenarios, as well as participants’ background characteristics, reasons for management, and procedural preferences. Data were analyzed using bivariate and multivariable analyses. Compared to 2011, participants in 2021 had 60% lower odds of preferring nonselective versus selective caries removal (OR 0.4, 95% CI 0.2–0.7) and endodontic treatment versus nonselective and selective caries removal (OR 0.4, 95% CI 0.2–0.6) in the scenario of asymptomatic and symptomatic (indicating reversible pulpitis at most) deep lesions, respectively. For exposed pulp, participants in 2021 had lower odds than in 2011 of preferring endodontic treatment versus vital pulp therapy (direct pulp capping and pulpotomies) for both scenarios without symptoms (OR 0.4, 95% CI 0.2–0.7) and with symptoms (OR 0.2, 95% CI 0.1–0.4). A higher proportion of respondents in 2021 reported using rubber dam (44% vs. 17% in 2011, p < 0.001) and hydraulic calcium silicate cements as a capping material (68% vs. 40% in 2011, p < 0.001). The management preferences were associated with the university of graduation and the number of years in dental practice, indicating “recommended in textbooks” and “recommended in scientific publications” as reasons for management preferences. To conclude, a change toward less invasive management options was observed. To a certain extent, dentists have implemented evidence-based recommendations in dental practice. To ensure further adoption of scientific evidence, dentists should be encouraged to update themselves on the newest evidence-based practices

Association between Carbonic Anhydrase VI (CA VI) gene copy number and dental caries experience

The current study examined the association between the carbonic anhydrase VI (CA VI) copy number variations (CNVs) and dental caries experience in adults. In total, 202 of 35-72 years old subjects participating in the Lithuanian National Oral Health Survey (LNOHS) agreed to provide saliva samples, thus their data were included in the current study. Information about sociodemographic, environmental, and behavioural determinants was acquired via the self-administered World Health Organisation (WHO) questionnaire. Fluoride levels in the drinking water were recorded based on information provided by water suppliers. Dental caries experience was recorded by one calibrated examiner using the WHO criteria for recording caries on smooth (including proximal, buccal, and oral) or occlusal surfaces. Caries experience was measured as the total number of decayed (D3), missing (M), filled (F) surfaces (D3MFS). DNA was extracted from saliva samples to examine CA VI CNVs using the QX200 droplet digital PCR system. Negative binomial regression and Poisson regression analyses were employed for data analyses. Based on multivariable regression analyses, higher copy number of CA VI were associated with higher caries experience on smooth surfaces (IRR 1.04, 95% CI 1.005 - 1.08) and occlusal surfaces (IRR 1.02, 95% CI 1.003 - 1.04). Positive associations between higher copy number of CA VI and higher caries experience on smooth and occlusal surfaces were found, suggesting that the CA VI coding gene may be associated with caries development. Future studies are needed to validate our results and to examine the underlying mechanisms of such associations

European student wellness, stress, coping, support and perceptions about remote dental training during COVID-19

Objectives: The aim of this study was to compare wellness, stress, ability to cope, social support and perceptions about remote training amongst European dental students during COVID-19. Methods: 1795 undergraduate dental students from six countries and eight dental schools participated. The anonymous survey collected data about different aspects in each of the following domains: wellness, stress, ability to cope, social support and perceptions about remote training. Complex multi-item scales were used for all domains. Results: There were differences amongst countries in all the domains. Overall, student stress scores were lower than either their coping or support scores. The highest wellness score (mean ±sd) was observed in Romania: 62.5% ± 11.2% whilst the highest mean stress scores were observed in Albania: 46.3% ± 11.7% and Lithuania: 42.2% ± 13.8%. Overall, student stress and coping ability scores were lower and their support scores higher. About 10% of students did not have any support. In the linear multivariable regression analysis, significant predictors of wellness were being female (β = 0.073), not being in a graduating year (β = 0.059), having less stress (β = 0.222), ability to cope (β = 0.223) and having support (β = 0.179). The student positive perceptions about remote training were predicted by less stress (β = 0.080), coping (β = 0.182) and support (β = 0.057). Conclusions: Students varied in wellness, stress, coping, social support and perceptions of remote training. Also, there were significant differences amongst students from different countries. Coping was the best predictor of both student wellness and their positive perceptions about remote training

Hvordan har tannhelsetjenesten i Norge håndtert pasienter og smittevern under den mest akutte fasen av covid-19-pandemien?

Source at https://www.tannlegetidende.no/i/2020/9/m-1912. The original research paper that is discussed is available in Munin at https://hdl.handle.net/10037/18994.Tannhelsetjenestens kompetansesenter Øst (TkØ) har gjennomført en spørreundersøkelse om tannhelsepersonells erfaringer under nedstenging i perioden 13. mars–17. april 2020. Første del av studien er nå publisert i International Journal of Environmental Research and Public Health og er den første norske studien som omhandler håndtering av covid-19-pandemien i tannhelsetjenesten

Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry?

Background - The concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions. Methods - We included 171 general dental practitioners and dental therapists (collectively referred to here as “dentists”) from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis. Results - For the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13–15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33–6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite. Conclusions - The majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results

Dental Health Services Response to COVID-19 in Norway

We aimed to investigate the management of urgent dental care, the perception of risk and workplace preparedness among dental staff in Norway during the COVID-19 pandemic. An electronic questionnaire regarding the strictest confinement period in Norway (13 March&ndash;17 April 2020) was distributed to dental staff. Among the 1237 respondents, 727 (59%) treated patients, of whom 170 (14%) worked in clinics designated to treat patients suspected or confirmed to have COVID-19. Out of them 88% (143) received training and 64% (103) simulation in additional infection prevention procedures, while 27 (24%) respondents reported deviation. In total, 1051 (85%) respondents perceived that dental staff had a high risk of being infected, 1039 (84%) that their workplace handled the current situation well, 767 (62%) that their workplace had adequate infection control equipment and 507 (41%) agreed that their workplace is well equipped to handle an escalation. Before an appointment, 1182 (96%) respondents always/often inquired per phone information if a patient experienced symptoms of COVID-19, and 1104 (89%) asked about a history of travel to affected areas. Twice as many patients on average per week were treated by phone than in a clinic. A lower proportion of dental staff in high incidence counties applied additional infection prevention measures compared to low and medium incidence counties. To conclude, urgent dental health care was managed relatively well in Norway. Additional training of the dental staff in adequate infection prevention and step-by-step procedures may be needed. These results may be used to improve the dental health service&rsquo;s response to future outbreaks

Using storytelling in undergraduate dental education: Students' experiences of emotional competence training

Aim: The aim of the study was to explore the use of storytelling as a teaching method for emotional competence interventions within undergraduate dental curriculum (dental and dental hygiene students). Materials and Methods: Students participated in five sessions related to emotional competence: one theoretical and four practical. During the latter, divided in small groups, students told individually two stories: a story about a clinical situation in which they had an emotional experience and a story concerning a patient's experience of the same emotion. Each session focused on a single emotion: happiness, fear, anger and shame. A questionnaire was used to collect perceptions about enjoyment, how stories were chosen, what was learned and if the sessions were stimulating in any way. A focus group was organised to collect reflections about the learning environment, process of learning and specific skill set developed during these sessions. Results: The majority of the students enjoyed listening, telling and preparing the stories. They reported to experience social support and feeling a sense of community during the sessions. The students believed that stories helped them to reflect on their clinical work and to regulate their emotional experiences more efficiently in clinical situations. Regarding the learning environment, the dental students pointed out the distinctiveness and dissimilarities between the dental and dental hygiene students, but also expressed that they had a desire to learn more about the other student group. Conclusion: Storytelling used as part of an emotional competence course appears to have benefits for students' reflection about their role as dental health professionals. This teaching method was well-perceived by the students included in this study