Research undertaken by staff affiliated to Dublin Dental University Hospital

Recent Submissions

  • Implementation of a food science and nutrition module in a dental undergraduate curriculum.

    Crowe, Michael; O'Sullivan, Michael; Winning, Lewis; Cassetti, Oscar; O'Connell, Brian; O'Sullivan, Aifric; Gibney, Eileen; Doyle, Suzanne L; Bennett, Annemarie; Moynihan, Paula (2022-05-17)
    Introduction: To outline the development and implementation of a food science and nutrition module for dental undergraduate students that provides basic knowledge and clinical skills for improving oral health outcomes and understanding their importance for overall health. Materials and methods: Interdisciplinary discussions with professionals with expertise in food science and nutrition, including dentists, dietitians and nutritionists, were held to agree on core subject areas in line with the evidence base. The module was delivered online to 2nd-year dental students due to COVID-19 restrictions. Students completed an online evaluation on completing the module. Final examination consisted of one essay question. Results: Subject areas and learning outcomes were derived from current and previous approaches to curriculum development. A total of 14 prerecorded lectures, including healthy eating guidelines, dietary assessment, specific oral effects of diet and food constituents were delivered and tutorials provided. The evaluation survey had a 90% (n = 39/43) response rate. A majority indicated that the course was "interesting," "worth doing" (59%) and "provided a good evidence base to understand nutrition and oral health" (87%). Nearly all students (92%) agreed that the course was "sufficiently structured to allow understanding of the key topics" and that "a good understanding of nutrition is important for a dentist" (95%). Conclusion: A food science and nutrition module developed by a multidisciplinary team enabled dental students to gain an understanding of the role of diet in oral and overall health. The module facilitated the development of skills that enable students to utilise dietary assessment techniques and promote dietary interventions beneficial to oral health. The approach taken may act as a template for other institutions.
  • The Impact of the First Wave of the COVID-19 Pandemic on Providing Special Care Dentistry: A Survey for Dentists.

    Limeres Posse, Jacobo; van Harten, Maria T; Mac Giolla Phadraig, Caoimhin; Diniz Freitas, Márcio; Faulks, Denise; Dougall, Alison; Daly, Blánaid; Diz Dios, Pedro (2021-03-14)
    This study aimed to investigate the impact of COVID-19 on the experiences of special care dentistry providers worldwide. An online survey was administered from 10 to 31 July 2020. Age, sex, years of professional activity, COVID-19 status, geographical area of origin and length of lockdown period were recorded for all participating dentists. The relationships between these variables and the changes in clinical activity, the treated patients' COVID-19 status and the implementation of protective measures in the dental clinic were analyzed. A total of 436 (70.6% women) dentists from 59 countries responded to the survey. Clinical activity was reduced or stopped for 79.1% of respondents. The most common change was to limit treatment to urgent care only (53.7%). Treatment under general anesthesia or deep sedation was discontinued (51.0%) or reduced (35.8%) for the majority of respondents. Male dentists were more likely to maintain their clinical activity than female dentists (p < 0.001), and respondents from North America were more likely to do so than participants from other geographical regions (p < 0.001). Dentists from Latin America and the Caribbean were more likely to report treatment of confirmed cases of COVID-19 than those from Europe (p < 0.001). The implementation of protective measures in the dental office was determined by the survey participant's sex, intensity of clinical activity and geographical area of origin. To conclude, the provision of special care dentistry was considerably reduced in response to the pandemic. Service maintenance was mainly related to the geographical area in which the surveyed dentists worked, further exacerbating pre-existing inequalities.
  • An epidemic CC1-MRSA-IV clone yields false-negative test results in molecular MRSA identification assays: a note of caution, Austria, Germany, Ireland, 2020.

    Monecke, Stefan; König, Elisabeth; Earls, Megan R; Leitner, Eva; Müller, Elke; Wagner, Gabriel E; Poitz, David M; Jatzwauk, Lutz; Vremerǎ, Teodora; Dorneanu, Olivia S; et al.
    We investigated why a clinical meticillin-resistant Staphylococcus aureus (MRSA) isolate yielded false-negative results with some commercial PCR tests for MRSA detection. We found that an epidemic European CC1-MRSA-IV clone generally exhibits this behaviour. The failure of the assays was attributable to a large insertion in the orfX/SCCmec integration site. To ensure the reliability of molecular MRSA tests, it is vital to monitor emergence of new SCCmec types and junction sites.
  • Histone Acetylation as a Regenerative Target in the Dentine-Pulp Complex.

    Yamauchi, Yukako; Cooper, Paul Roy; Shimizu, Emi; Kobayashi, Yoshifumi; Smith, Anthony J; Duncan, Henry Fergus (2020-02-06)
    If dental caries (or tooth decay) progresses without intervention, the infection will advance through the dentine leading to severe pulpal inflammation (irreversible pulpitis) and pulp death. The current management of irreversible pulpits is generally root-canal-treatment (RCT), a destructive, expensive, and often unnecessary procedure, as removal of the injurious stimulus alone creates an environment in which pulp regeneration may be possible. Current dental-restorative-materials stimulate repair non-specifically and have practical limitations; as a result, opportunities exist for the development of novel therapeutic strategies to regenerate the damaged dentine-pulp complex. Recently, epigenetic modification of DNA-associated histone 'tails' has been demonstrated to regulate the self-renewal and differentiation potential of dental-stem-cell (DSC) populations central to regenerative endodontic treatments. As a result, the activities of histone deacetylases (HDAC) are being recognised as important regulators of mineralisation in both tooth development and dental-pulp-repair processes, with HDAC-inhibition (HDACi) promoting pulp cell mineralisation in vitro and in vivo. Low concentration HDACi-application can promote de-differentiation of DSC populations and conversely, increase differentiation and accelerate mineralisation in DSC populations. Therapeutically, various HDACi solutions can release bioactive dentine-matrix-components (DMCs) from the tooth's extracellular matrix; solubilised DMCs are rich in growth factors and can stimulate regenerative processes such as angiogenesis, neurogenesis, and mineralisation. The aim of this mini-review is to discuss the role of histone-acetylation in the regulation of DSC populations, while highlighting the importance of HDAC in tooth development and dental pulp regenerative-mineralisation processes, before considering the potential therapeutic application of HDACi in targeted biomaterials to the damaged pulp to stimulate regeneration.
  • Linezolid resistance in Enterococcus faecium and Enterococcus faecalis from hospitalized patients in Ireland: high prevalence of the MDR genes optrA and poxtA in isolates with diverse genetic backgrounds.

    Egan, Sarah A; Shore, Anna C; O'Connell, Brian; Brennan, Grainne I; Coleman, David C (2020-07)
    Objectives: To investigate the prevalence of the optrA, poxtA and cfr linezolid resistance genes in linezolid-resistant enterococci from Irish hospitals and to characterize associated plasmids. Methods: One hundred and fifty-four linezolid-resistant isolates recovered in 14 hospitals between June 2016 and August 2019 were screened for resistance genes by PCR. All isolates harbouring resistance genes, and 20 without, underwent Illumina MiSeq WGS. Isolate relatedness was assessed using enterococcal whole-genome MLST. MinION sequencing (Oxford Nanopore) and hybrid assembly were used to resolve genetic environments/plasmids surrounding resistance genes. Results: optrA and/or poxtA were identified in 35/154 (22.7%) isolates, the highest prevalence reported to date. Fifteen isolates with diverse STs harboured optrA only; one Enterococcus faecium isolate harboured optrA (chromosome) and poxtA (plasmid). Seven Enterococcus faecalis and one E. faecium harboured optrA on a 36 331 bp plasmid with 100% identity to the previously described optrA-encoding conjugative plasmid pE349. Variations around optrA were also observed, with optrA located on plasmids in five isolates and within the chromosome in three isolates. Nine E. faecium and 10 E. faecalis harboured poxtA, flanked by IS1216E, within an identical 4001 bp region on plasmids exhibiting 72.9%-100% sequence coverage to a 21 849 bp conjugative plasmid. E. faecalis isolates belonged to ST480, whereas E. faecium isolates belonged to diverse STs. Of the remaining 119 linezolid-resistant isolates without linezolid resistance genes, 20 investigated representatives all harboured the G2576T 23S RNA gene mutation associated with linezolid resistance. Conclusions: This high prevalence of optrA and poxtA in diverse enterococcal lineages in Irish hospitals indicates significant selective pressure(s) for maintenance.
  • Estimation and consumption pattern of free sugar intake in 3-year-old Irish preschool children.

    Crowe, Michael; O'Sullivan, Michael; Cassetti, Oscar; O'Sullivan, Aifric (2019-07-19)
    Purposes: Dietary free sugars (FS) are the most important risk factor for dental caries and can contribute to excess energy intake. Measuring FS intake is limited by food composition databases and appropriate dietary assessment methods. The aim of this analysis was to estimate total sugar (TS) and FS intakes for Irish pre-schoolers and examine the proportion of dietary TS and FS captured using a short food questionnaire (SFQ). Methods: This is a secondary analysis of 3-year-old children from two national surveys; Growing Up in Ireland (GUI), N = 9793 of whom 49% were girls and the National Preschool Nutrition Survey (NPNS), N = 126 and 52% were girls. GUI used SFQs and NPNS used semi-weighed food diaries to collect dietary data from 3-year-old children. Dietary intake databases were linked using an established approach. Mean daily TS and FS intakes and frequency were calculated, and consumption patterns from foods and meals are presented. The proportion of foods that were covered or non-covered by the GUI SFQ was calculated by comparison with the NPNS food diary. Results: 75% of 3 year-olds had FS intake greater than the maximum recommended by WHO guidelines for free sugar intake, while 4% met the lower threshold. The median frequency of TS and FS consumption was 5.0 (4.0-6.0) and 4.0 (3.0-5.0) times/day. Less than one-quarter of TS intake (g/day) was non-covered by the GUI SFQ while less than one-third of FS intake was non-covered. Conclusions: A large majority of 3-year-old Irish children do not meet the WHO recommended guidelines for FS intake and almost none meet the desired conditional recommendation. SFQs only capture two-thirds of FS intake at this early age.
  • Down syndrome and oral health: mothers' perception on their children's oral health and its impact.

    AlJameel, AlBandary H; Watt, Richard G; Tsakos, Georgios; Daly, Blánaid (2020-06-16)
    Background: Individuals with Down syndrome exhibit particular oro-facial characteristics that may increase their risk of oral health problems. However, there is little research on the oral health of children and adults with Down syndrome and the way that oral health may affect Quality of Life (QoL). This study explored mothers' perceptions of the oral health problems experienced by their children with Down syndrome and how these reported problems impacted the lives of the children and their families. Methods: The study involved 20 in-depth, semi-structured interviews with mothers of children and adolescents aged 12-18 years with Down syndrome attending special care centres in Riyadh, Saudi Arabia. Results: The predominant oral-health related problem reported by mothers was difficulty in speaking. Mothers also reported that tooth decay and toothache were problems that had undesirable effects on different aspects of their children's QoL including: performing daily activities, emotional wellbeing, and social relationships. Poor oral health and functional problems had direct and indirect impacts on the family's QoL as well. Conclusion: Mothers perceived an array of QoL impacts from oral conditions, which affected their child with Down syndrome and the wider family.
  • A novel multidrug-resistant PVL-negative CC1-MRSA-IV clone emerging in Ireland and Germany likely originated in South-Eastern Europe.

    Earls, Megan R; Shore, Anna C; Brennan, Gráinne I; Simbeck, Alexandra; Schneider-Brachert, Wulf; Vremerǎ, Teodora; Dorneanu, Olivia S; Slickers, Peter; Ehricht, Ralf; Monecke, Stefan; et al. (2019-01-21)
    This study investigated the recent emergence of multidrug-resistant Panton-Valentine leukocidin (PVL)-negative CC1-MRSA-IV in Ireland and Germany. Ten CC1-MSSA and 139 CC1-MRSA isolates recovered in Ireland between 2004 and 2017 were investigated. These were compared to 21 German CC1-MRSA, 10 Romanian CC1-MSSA, five Romanian CC1-MRSA and two UAE CC1-MRSA, which were selected from an extensive global database, based on similar DNA microarray profiles to the Irish isolates. All isolates subsequently underwent whole-genome sequencing, core-genome single nucleotide polymorphism (cgSNP) analysis and enhanced SCCmec subtyping. Two PVL-negative clades (A and B1) were identified among four main clades. Clade A included 20 German isolates, 119 Irish isolates, and all Romanian MRSA and MSSA isolates, the latter of which differed from clade A MRSA by 47-130 cgSNPs. Eighty-six Irish clade A isolates formed a tight subclade (A1) exhibiting 0-49 pairwise cgSNPs, 80 of which harboured a 46 kb conjugative plasmid carrying both ileS2, encoding high-level mupirocin resistance, and qacA, encoding chlorhexidine resistance. The resistance genes aadE, aphA3 and sat were detected in all clade A MRSA and the majority (8/10) of clade A MSSA isolates. None of the clade A isolates harboured any enterotoxin genes other than seh, which is universally present in CC1. Clade B1 included the remaining German isolate, 17 Irish isolates and the two UAE isolates, all of which corresponded to the Western Australia MRSA-1 (WA MRSA-1) clone based on genotypic characteristics. MRSA within clades A and B1 differed by 188 cgSNPs and clade-specific SCCmec characteristics were identified, indicating independent acquisition of the SCCmec element. This study demonstrated the existence of a European PVL-negative CC1-MRSA-IV clone that is distinctly different from the well-defined PVL-negative CC1-MRSA-IV clone, WA MRSA-1. Furthermore, cgSNP analysis revealed that this newly defined clone may have originated in South-Eastern Europe, before spreading to both Ireland and Germany.
  • Dental interventions in patients taking anti-resorptive medication for the treatment of osteoporosis and other bone disease: an audit of current practice in the Dublin Dental University Hospital

    Henry, Cian; Stassen, Leo F.A.; O’Reilly, Rory (Irish Dental Association, 2017-11)
    Medication-related osteonecrosis of the jaws (MRONJ) is a well-established complication of anti-resorptive and, more recently, anti-angiogenic therapy. The dental profession has a pivotal role to play in the prevention and management of this debilitating condition, and all dentists have a responsibility to remain cognisant of national and international best practice guidelines in the prevention of this disease process. The management of patients in the Dublin Dental University Hospital at risk of MRONJ when carrying out dental interventions was audited against nationally- and internationally-published guidelines. The results of the audit showed compliance with the national and international guidance in 5% and 0% of cases, respectively. The most common measures implemented in the management of patients at risk of MRONJ were: preoperative antibiotics in 49% of cases; preoperative chlorhexidine mouthwash in 76%; plain local anaesthetic in 51%; and, post-operative antibiotics in 80%.
  • Tips for splinting traumatised teeth

    Leith, Rona; O’Connell, Anne C. (Irish Dental Association, 2017-11)
    A splint is required when teeth are mobile or need to be repositioned following a traumatic injury. The aim of splinting is to stabilise the injured tooth and maintain its position throughout the splinting period, improve function and provide comfort. Current best practice guidelines from the International Association for Dental Traumatology (IADT) recommend splinting for luxated, avulsed, root fractured and traumatically loosened permanent teeth.1,2 Splinting of primary teeth is usually not feasible. In general, the prognosis of a traumatised tooth is determined by the type of injury rather than the type of splint.3 However, correct splinting is important to maximise healing of the soft and hard tissues, and prevent further injury.1
  • An audit of the baseline dental status and treatment need of individuals referred to Dublin Dental University Hospital for a pre-radiotherapy dental and oral assessment

    MacCarthy, Denise (Irish Dental Association, 2017-11)
    he objectives of this audit were to establish the baseline dental status and treatment need of pre-radiation head and neck cancer patients in Ireland.
  • Tips for splinting traumatised teeth

    Leith, Rona; O’Connell, Anne C. (Irish Dental Association, 2017-10)
    A splint is required when teeth are mobile or need to be repositioned following a traumatic injury. The aim of splinting is to stabilise the injured tooth and maintain its position throughout the splinting period, improve function and provide comfort. Current best practice guidelines from the International Association for Dental Traumatology (IADT) recommend splinting for luxated, avulsed, root fractured and traumatically loosened permanent teeth.1,2 Splinting of primary teeth is usually not feasible. In general, the prognosis of a traumatised tooth is determined by the type of injury rather than the type of splint.3 However, correct splinting is important to maximise healing of the soft and hard tissues, and prevent further injury.1-6
  • An audit of the baseline dental status and treatment need of individuals referred to Dublin Dental University Hospital for a pre-radiotherapy dental and oral assessment

    MacCarthy, Denise; Clarke, Mary; O’Regan, Myra (Irish Dental Association, 2017-10)
    The objectives of this audit were to establish the baseline dental status and treatment need of pre-radiation head and neck cancer patients in Ireland
  • Dental interventions in patients taking anti-resorptive medication for the treatment of osteoporosis and other bone disease: an audit of current practice in the Dublin Dental University Hospital

    Henry, Cían J.; O’Reilly, Rory; Stassen, Leo F.A. (Irish Dental Association, 2017-10)
    Medication-related osteonecrosis of the jaws (MRONJ) is a well-established complication of anti-resorptive and, more recently, anti-angiogenic therapy. The dental profession has a pivotal role to play in the prevention and management of this debilitating condition, and all dentists have a responsibility to remain cognisant of national and international best practice guidelines in the prevention of this disease process.
  • Plaque control and oral hygiene methods

    Harrison, Peter; Dublin Dental Hospital (Irish Dental Association, 2017-06)
    The experimental gingivitis study of Löe et al.1 demonstrated a cause and effect relationship between plaque accumulation and gingival inflammation, and helped to establish plaque/biofilm as the primary risk factor for gingivitis. When healthy individuals withdrew oral hygiene efforts, gingival inflammation ensued within 21 days in all subjects. Once effective plaque removal was recommenced, clinical gingival health was quickly re-established – indicating that plaque-associated inflammation is modifiable by plaque control. As current consensus confirms that gingivitis and periodontitis may be viewed as a continuum of disease,2 the rationale for achieving effective plaque control is clear.
  • First tooth, first visit, zero cavities: a review of the evidence as it applies to Ireland

    Duane, Brett; McGovern, Eleanor; Ní Chaollaí, Aifric; FitzGerald, Kirsten (Journal of Irish Dental Association, 2017-04)
    In recent years several studies have demonstrated that dental caries is already well established by the time a child reaches three years of age. In Scotland, for example, three-year-old children had a caries prevalence of 25%, with a higher rate of 32% in children living in deprived areas, when examined in 2007/2008.1 In England in 2013, 12% of three-year-old children had experienced dental decay and those children with dental disease had approximately three teeth that were decayed, missing or filled.
  • Ready to crown

    McReynolds, David (Journal of the Irish Dental Association, 2017-04)
    When multiple teeth or localised segments of the mouth require crowns, the restorative interventions involved can be psychologically and physically demanding for the operator, patient and dental technician alike.1,2 It is important that all parties involved in restorations of this nature hold a shared understanding of the expected outcome of treatment, with a realistic, common end goal in mind right from the very beginning. Such clarity of thought and communication is key to avoiding biological, mechanical and aesthetic failures in the planning and execution of advanced restorative treatments. Biomechanically stable and aesthetically pleasing provisional restorations are an essential aspect of treatment, which allow teeth to be prepared and provisionalised over multiple appointments within the comfort zone of the operator and patient.3
  • The non-healing extraction socket: a diagnostic dilemma – case report and discussion

    Henry, Cian (Irish Dental Assocation (IDA), 2016-08)
    Although the healing of extraction sockets is generally a rapid and uncomplicated process, delayed healing, overt infection, or failure of recent exodontia sites to heal can occur. Delayed healing is reported to occur in less than 11% of all extractions.1 A variety of factors may be implicated and the dental clinician must be aware pre-operatively of both local and systemic influences. The vast majority of cases are the result of innocuous, local factors such as dry socket or infection.1 However, the potentially life-threatening, malignant lesions complicating this phenomenon can be underestimated.2-8 Therefore, it is incumbent on dental professionals to familiarise themselves with the normal inflammatory and reparative processes involved in the restitution of mucosal continuity which follow extraction, and the potential pathological lesions that interfere with healing. Failure of an extraction socket to exhibit satisfactory signs of healing in a timely manner (within three to four weeks) warrants urgent referral to an oral and maxillofacial surgeon for investigation.
  • Clinical and radiographic assessment of maxillary canine eruption status in a group of 11- to 14-year-old Irish children

    Daly, Kieran T. (Irish Dental Assocation (IDA), 2016-06)
    In this study of 480 11- to 14-year-old Irish schoolchildren, 1.1% of the maxillary canines reviewed showed a potentially ectopic eruption position.
  • Prospective audit of postoperative instructions to patients undergoing root canal treatment in the DDUH and re-audit following introduction of a written patient information sheet

    Moorthy, A; Alkadhimi, AF; Stassen, Leo F; Duncan, HF (Irish Dental Assocation (IDA), 2016-02)
    An audit of the delivery and documentation of postoperative instructions to patients undergoing root canal treatment in the DDUH demonstrated unfavourable results compared to the ideal benchmark. Introduction of a postoperative leaflet significantly improved the content and consistency of the advice and will be implemented in future

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