Caries and the older patient Hayes, Martina; McReynolds, David E
Journal of the Irish Dental Association,
6/2023
Journal Article
Population ageing is global and pervasive and in Ireland, we can expect to see the proportion of the population aged over 65 grow to nearly 30% in the next thirty years. Along with this we have seen ...a reduction in tooth loss. Therefore we will be managing increasing numbers of partially and fully dentate older adults in dental practice. Older adults in Ireland have high levels of past caries experience and, in particular, root caries is almost exclusively a disease seen in this cohort. Preventing and managing caries in older adults with heavily restored dentitions will bring both treatment planning and operative challenges to the dental profession.
Capnography monitoring during conscious sedation is not
currently required for dentistry in Britain and Ireland. Other
countries have introduced guidelines and standards requiring
capnography ...monitoring for procedural sedation. This review
highlights the variability of procedural sedation including the
setting, the position on the sedation continuum, and the routine
use of supplemental oxygen. Specific research is required for
conscious sedation in a dental setting to support standards and
guidelines with regard to capnography monitoring.
The Academy of Medical Royal Colleges and their Faculties
emphasise that each specialty must produce its own guidance for
the use of sedative techniques.1 Clinical practice guidelines for the
monitoring and safe practice of sedation vary by specialty and
institution. Standards are generally set from the best available
evidence based research. There is a growing body of literature that
recognises the potential additional value of capnography (ETCO2)
monitoring during procedural sedation in different settings and for
different sedation techniques.2-5 In these studies, capnography
reduced the incidence of hypoxaemia during procedural sedation.
A meta-analysis published by Waugh et al. (2010) concluded that
end-tidal carbon dioxide monitoring is an important addition in
detecting respiratory depression during procedural sedation.6 A
more recent systematic review by Conway et al. (2016) concluded
that patients monitored with capnography in addition to standard
monitoring had a reduced risk of hypoxaemia compared to those
with only standard monitoring.7 However, it has to be noted that
both the Waugh and Conway reviews contained substantial
statistical heterogenicity which is likely to affect the quality of the
evidence.
As research evidence for capnography monitoring from the
medical settings studied became available, new standards for
capnography monitoring were introduced in several countries
(Table 1).
Ten million people in the UK today are aged over 65. The latest projections estimate that there will be 5 1/2 million more people aged 65 and older in the next 20 years. This projected pattern of ...population ageing will have profound consequences for dentistry. Minimal intervention dentistry (MID) is a modern evidence-based approach to caries management in dentate patients that uses the 'medical model' whereby disease is controlled by the 'oral physician'. This approach offers considerable benefits over conventional dentistry for older patients. It encourages patients to be responsible for their oral health through the provision of both knowledge and motivation. MID encompasses risk assessment for dental disease, early detection and control of disease processes, and minimally invasive treatment. Clinical Relevance: Risk assessment tools can aid the general dental practitioner and the patient to develop a suitable caries prevention programme for that individual and reduce the need for future operative intervention.
The World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions was convened in 2017 and resulted in the publication of a new classification system in 2018.1 This ...replaces the formerly used 1999 (Armitage) Classification.2 The complete Workshop proceedings are available to clinicians for free online via the European Federation of Periodontology (EFP) website.3
The new process for diagnosing and classifying cases of periodontitis incorporates staging and grading of each case.4 At its simplest, the stage represents an interpretation of periodontitis severity and complexity of management of the case. The grade provides supplemental evidence on the historic rate of disease progression, and can help to identify cases where risk factors exist and/or where expected outcomes of therapy may be less favourable.5
Diagnostic decision trees may be of value to practitioners in applying the new classification in daily practice. The current series utilises the decision tree published by the British Society of Periodontology (BSP),6 as this arguably represents the simplest approach to classifying periodontitis cases.
##Statement of the problem Pathological tooth surface loss (TSL) is an increasing challenge for dental healthcare professionals (DHCPs). Patients with eating disorders (EDs) may present with TSL and ...future DHCPs should be aware of the medical, dental and general management of patients with EDs who may present with TSL.
##Purpose of the study Determine perceptions of undergraduate students at Cork University Dental School and Hospital (CUDSH) regarding their training and the management of eating disorders.
##Methods A questionnaire was distributed to final year dental (FYD; n=47) and dental hygiene (FYDH;n=14) students approaching the end of their studies at University College Cork.
##Results A response rate of 40% for FYD (n=19) and 86% for FYDH (n=12) students showed no obvious trends differentiating between perceptions of FYDs and FYDHs. The perceived confidence of students in managing patients with EDs varied widely. A number of respondents perceived inadequate training in relation to oral manifestations (32%) and dental management (16%) of patients with EDs. In relation to the medical management (90%), personality traits (71%) and psychological needs (81%), students perceived a requirement for further training. A total of 77% of respondents were unaware of local support services available to ED patients, with 94% also unaware of Eating Disorder Centre Cork (EDCC).
##Conclusion There is a need for improvement within the dental curricula in education regarding patients with EDs, specifically their comprehensive management by DHCPs and surrounding services.
##Aim This study aimed to explore the attitudes of dentists in Ireland towards the phase-down of dental amalgam in relation to the Minamata Convention on Mercury.
##Methods A cross-sectional survey ...design was adopted using a quantitative 53-question survey piloted and distributed to dentists working in general dental practice.
##Results The study had a response rate of 11.8% (n=285). The study found a high level of awareness regarding recommended guidelines concerning the Minamata Convention on Mercury, with 96% of participants reporting that they were aware of the recommendations. Over half of the participants (61%) reported that they felt the phase-down was a good idea.
##Conclusions Training and remuneration were identified as the main barriers to a total phase-out of dental amalgam in Ireland in the future.
##Aim This study aimed to investigate the use and waste management of dental amalgam and mercury-free alternatives by general dental practitioners in Ireland.
##Methods A cross-sectional survey-based ...study was adopted. A 53-question survey was piloted and distributed to dentists working in general dentistry in Ireland. Participants were recruited from the Dental Council of Ireland Dental Register.
##Results A total of 285 dentists (12%) responded to the survey. The study found that resin composite was the most commonly placed restorative material by respondents (69%), followed by dental amalgam (20%). Compliance with waste management of dental amalgam was high, with 93% of respondents reporting having a waste management policy concerning the disposal of waste amalgam and 87% compliance with the fitting of amalgam separators.
##Conclusions The study found that dentists in Ireland are compliant with the Minamata Convention on Mercury, and identified training and remuneration as two of the main barriers to implementing a total phase-out of dental amalgam.
To describe an early-onset adverse reaction following the injection of facial fillers, and to summarise the current legislation and research regarding cosmetic dermal fillers. To emphasise that ...dermal fillers should be considered as part of a general dental practitioner's differential diagnosis for lower lip swelling.
(1) To describe the types of adverse reactions associated with dermal fillers in the literature; (2) to summarise the current European and Irish legislation and guidance regarding the use of these products; and, (3) to present a case study of an early-onset adverse reaction.
Dentists should question patients regarding the use of cosmetic dermal fillers as part of the differential diagnosis of any intra-oral painless swelling where other pathology cannot be identified.
To describe the patterns of dental attendance and attitudes towards tooth loss of general dental practice patients in Galway.
1. To determine the pattern of adult dental attendance in general ...practices in Galway; and, 2. To examine the oral health attitudes of these patients.
Questionnaires were distributed to 311 consecutive adult patients in the waiting rooms of ten general dental practices in Galway, which were randomly selected from the telephone directory.
A total of 254 of the 311 questionnaires distributed were fully completed, returned and included in the results, giving a response rate of 81.7%. A total of 59% of dentate participants attended their dentist for annual or biannual examinations compared to 23% of edentate patients. Some 10.5% of medical card holders and 0.5% of non-medical card holders were edentulous.
The data from the survey indicated that medical card holders in Galway were more likely to be edentulous than nonmedical card holders. Edentate patients were less likely to be regular dental attenders than dentate patients.
