• Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study.

      Riordain, R Ni; Meaney, S; McCreary, C; Cork University Dental School and Hospital, Wilton, Cork, Ireland. richeal.niriordain@ucc.ie (2011-04)
      Chronic oral mucosal conditions impact upon the experience of daily life of patients in a variety of areas from physical health and functioning, to concerns about their future. The role of the oral medicine practitioner in treating patients with chronic oral mucosal diseases extends beyond active management and symptomatic relief to the management of all aspects of these conditions that impact upon their daily lives.
    • Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up.

      McKenna, Gerald; Allen, Patrick Finbarr; Hayes, Martina; DaMata, Cristiane; Moore, Ciaran; Cronin, Michael (Plos One, 2018-01-01)
      This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL). 89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment. Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group. Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.
    • The importance of oral health for the systemic well being of an ageing population.

      McKenna, G; Allen, P F; O'Mahony, D; DaMata, C; Cronin, M; Woods, N (2011-02-22)
    • Initial arch wires for alignment of crooked teeth with fixed orthodontic braces.

      Wang, Yan; Jian, Fan; Lai, Wenli; Zhao, Zhihe; Yang, Zhi; Liao, Zhengyu; Shi, Zongdao; Wu, Taixiang; Millett, Declan T; McIntyre, Grant T; et al. (2010)
      There is some evidence to suggest that there is no difference between the speed of tooth alignment or pain experienced by patients when using one initial aligning arch wire over another. However, in view of the general poor quality of the including trials, these results should be viewed with caution. Further RCTs are required.
    • Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation.

      Zaitoun, H; North, S; Lee, S; Albadri, S; McDonnell, S T; Rodd, H D; Department of Paediatric Dentistry, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2SZ. halla.zaitoun@sth.nhs.uk (2010-03-27)
      This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.
    • Intracranial abscess secondary to dental infection

      Brady, Paul; Bergin, Sarah; Cryan, Bartley; Flanagan, Oisin (Irish Dental Association, 2014-03)
      The oral cavity is considered as being home to a rich and abundant microflora, including Aggregatibacter actinomycetemcomitans (A. ac tinomyc etemcomitans), which is recognised as one of the major pathogens in destructive periodontal disease.1 A cerebral abscess linked to a dental source is a rare occurrence, since in most individuals the blood-brain barrier, along with the immune response, will exclude bacteria. In this age of antibiotics and with modern living conditions, pyogenic brain infections of odontogenic origin are uncommon in western society. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by haematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. Brain abscesses thought to be of dental origin have been reported to have a lethal outcome.2
    • Is tooth wear in the primary dentition predictive of tooth wear in the permanent dentition? Report from a longitudinal study.

      Harding, M A; Whelton, H P; Shirodaria, S C; O'Mullane, D M; Cronin, M S; Oral Health Services Research Centre, University College Cork, Ireland. m.harding@ucc.ie (2010-03)
      Males had more tooth wear than females. An association existed between tooth wear recorded at age 5 and molar tooth wear recorded at age 12. Tooth wear is a lifelong cumulative process and should be recorded in both the primary and permanent dentitions.
    • Juvenile idiopathic arthritis (JIA): a screening study to measure class II skeletal pattern, TMJ PDS and use of systemic corticosteroids.

      Mandall, Nicky A; Gray, Robin; O'Brien, Kevin D; Baildam, Eileen; Macfarlane, Tatiana V; Davidson, Joyce; Sills, John; Foster, Helen; Gardner-Medwin, Janet; Garrahy, Ann; et al. (2010-03)
      Just under one-third of oligoarticular and polyarticular JIA patients exhibited a moderate or severe class II skeletal pattern. It is, therefore, likely that any future clinical trial to investigate the effect of functional appliance treatment in JIA patients, will need multicentre co-operation to fulfil potential sample size requirements. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low except for crepitus and click. However, radiographic evidence of condylar erosion was high particularly in the polyarticular group. Use of systemic corticosteroids was prescribed more in polyarticular cases and this is likely to reflect the severity of the disease.
    • The McKesson prop--an essential tool for the emergency physician?

      Murphy, A P; Doran, H J; O'Sullivan, I; Sleeman, D; Cusack, S P A; Department of Emergency Medicine, Cork University Hospital, Cork, Ireland. adrianmurphy06@eircom.net (2010-02)
      Facial trauma is a commonly encountered presentation to emergency departments. When associated airway compromise occurs, co-existing head and neck injuries serve to produce a challenging clinical situation. We describe two patients who suffered multi-system trauma, with severe maxillofacial injuries that necessitated prompt definitive airway management and mid-face stabilisation in the pre-hospital and emergency department phases of resuscitation. The McKesson prop is a simple yet highly effective tool for use in these injuries.
    • Milestones in oral health services in the Republic of Ireland

      McDonnell, M (Irish Dental Association, 2012-06)
    • Motivational interviewing for dental clinicians

      Curtin, Sharon; Trace, Anna; Ziada, Hassan (Irish Dental Association, 2014-03)
      Motivational interviewing (MI) is a client centred therapeutic approach, which has been found to be an effective intervention for healthcare change, as it helps to enhance clients’ commitment to the process of change and enables them to resolve their ambivalence to it.1 It is also highly effective when used as a prelude to treatment, for example cognitive behavioural therapy, and its effects appear to endure over time.2 This endurance is attributed to its effects on retention of what is learned and on adherence to the treatment. MI is relevant for healthcare professionals, especially those working in the medical setting where, as Miller and Rollnick3 point out, “motivational issues in patient behaviour change are quite common” (p.35). Furthermore, research has shown that clients working with MI-trained healthcare practitioners were more highly motivated to change.
    • Multiple myeloma presenting as mandibular pain

      Crowley, Miriam (Irish Dental Association, 2016-10)
      Introduction: Multiple myeloma (MM) is a systemic malignancy of plasma cells defined by monoclonal production of circulating immunoglobulins. Bone pain is a presenting feature in the majority of cases. Treatment may involve intravenous use of bisphosphonates, chemotherapy or haematopoietic stem cell transplantation. Here, we illustrate a first presentation of MM in a patient with mandibular pain and discuss radiographic, diagnostic and treatment challenges of orofacial issues in patients with MM. Case report: A 69-year-old lady presented to an emergency oral surgery clinic with a month-long history of unilateral left-sided pain in her jaw. Examination revealed a buccolingual swelling of 2cm diameter in the lower left premolar region. Radiographic images demonstrated a 2cm lytic lesion in her mandible corresponding with the symptomatic region. Aspiration of the lesion was performed and histological analysis indicated an abundance of atypical plasma cells. Subsequent biopsy revealed sheets of plasmacytoid cells suggesting evidence of a plasmacytoma. Skeletal survey, bone marrow biopsy and serum analysis confirmed the presence of MM. Discussion: MM, although a systemic malignancy, can present via a variety of orofacial manifestations. The presence of a lytic lesion on plain radiographs should alert the dental practitioner to the possibility of the diagnosis. Treatment of orofacial bone pain may respond to intravenous bisphosphonates but care must be taken to avoid osteonecrosis of the jaw. Conclusion: This case is an important reminder of the potential oral presentations of MM and underlines the importance of radiographic evaluation in patients with atypical symptoms and presentations.
    • A national study on the attitudes of Irish dental faculty members to faculty development.

      O'Sullivan, E M; Oral & Maxillofacial Surgery Department, Cork University Dental School & Hospital, University College Cork, Cork, Ireland. eleanor.osullivan@ucc.ie (2010-02)
      This study indicates that targeted educational interventions, with content and delivery tailored to the specific needs of recipients, are most likely to succeed.
    • NICE guideline on antibiotic prophylaxis against infective endocarditis: attitudes to the guideline and implications for dental practice in Ireland.

      Ríordáin, R Ní; McCreary, C; Cork University Dental School and Hospital, Wilton, Cork, Ireland. richeal.niriordain@ucc.ie (2009-03-28)
      To enable patient re-education regarding antibiotic prophylaxis, dental practitioners must keep abreast of changes to current guidelines and understand the rationale driving these changes. Difficulties arise for dental practitioners when there is no national statutory body endorsing such guidelines, particularly now that the guidelines in relation to antibiotic prophylaxis in dentistry are so different.
    • Occlusal accommodation and mouthguards for prevention of orofacial trauma.

      Geary, Julian Lindsay; Clifford, Thomas Joseph; Kinirons, Martin James; Paediatric and Preventive Dentistry, School of Medicine and Dentistry, Queen's University Belfast, BT12 6BA, UK. l.geary@qub.ac.uk (2009)
      Within the limitations of this study, the modification of the occlusal surface made by flat grinding reduced the arch separation in eccentric movements and increased the opposing tooth contacts in custom-made mouthguards. This may contribute to increased comfort, compliance and the protective effect of these appliances thus resulting in a reduction of injuries to the teeth, arches and soft tissues.
    • Oral cancer--current knowledge, practices and implications for training among an Irish general medical practitioner cohort.

      Ni Riordain, Richeal; McCreary, Christine; Oral Medicine Unit, Cork University Dental School and Hospital, Wilton, Cork, Ireland. richeal.niriordain@ucc.ie (2009-11)
      This study investigated the current knowledge and practices of general medical practitioners (GMPs) in Ireland regarding the examination of the oral cavity and the detection of oral malignancy and the training they had received at both undergraduate and postgraduate level and since commencing in practice. A questionnaire survey of GMPs in Ireland was conducted. One hundred and fifty four (65.3%) of the practitioners reported regularly examining the oral mucosa of their patients. Almost half of these (n=68) further qualified this response by stating that they only examined the oral mucosa if the patient reported pain in this area or if the patient specifically requested an oral examination for some reason. Eighty one (34.3%) practitioners surveyed felt confident in their ability to detect oral malignancies with the remaining two thirds unsure of whether they would be able to detect oral cancer. There was a significant association between the undergraduate and postgraduate teaching on examination of the oral cavity and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=4.811, p<0.05]. A statistically significant association was also found between the undergraduate and postgraduate teaching on the diagnosis of oral malignant disease and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=6.194, p<0.05]. In conclusion the level of knowledge of Irish general medical practitioners needs to be addressed with appropriate initiatives both at undergraduate level and via CME.
    • Oral medicine and the elderly.

      McCreary, Christine; Ní Ríordáin, Richeal; Cork University Dental School and Hospital, Wilton, Cork, Ireland. (2011-03-15)
      A focus often exists in dental practice on the maintenance and management of the dentition and the periodontium, however, conditions of the oral mucosa and orofacial pain can cause significant problems for older patients. Oral mucosal conditions are more prevalent in older patients and many orofacial pain disorders, such as burning mouth syndrome and trigeminal neuralgia, are more common in patients over the age of 50 years. Although these conditions may not be routinely managed in general practice, identification of these patients in primary care and appropriate referral will lead to more prompt and effective treatment. CLINICAL RELEVANCE: Dental practitioners need to be able to identify what is considered to be within the normal physiological limits of the ageing oral tissue and hence what is abnormal and requires further investigation to facilitate appropriate referral.
    • Periodontitis and type 2 diabetes: is oxidative stress the mechanistic link?

      Allen, E M; Matthews, J B; O'Connor, R; O'Halloran, D; Chapple, I L C; Dept. of Restorative Dentistry, Cork University Dental School & Hospital, Cork, Ireland. e.allen@ucc.ie (2009-05)
      Periodontitis is a common, chronic inflammatory disease initiated by bacteria which has an increased prevalence and severity in patients with type 2 diabetes. Recent studies indicate that the co-morbid presence of periodontitis can, in turn, adversely affect diabetic status and the treatment of periodontitis can lead to improved metabolic control in diabetes patients. Current evidence points to a bidirectional interrelationship between diabetes and inflammatory periodontitis. The importance of oxidative stress-inflammatory pathways in the pathogenesis of type 2 diabetes and periodontitis has recently received attention. Given the bidirectional relationship between these two conditions, this review discusses the potential synergistic interactions along the oxidative stress-inflammation axis common to both type 2 diabetes and periodontitis, and the implications of this relationship for diabetic patients.
    • A qualitative study of trends in patient preferences for the management of the partially dentate state.

      Cronin, Mary; Meaney, Sarah; Jepson, Nicholas J A; Allen, P Finbarr; Department of Public Health and Epidemiology, Brookfield, Cork, Ireland. (2009-06)
      The evidence of a cohort effect within this study in relation to higher patient expectations indicates that both contemporary and future patients are likely to seek a service based on conservation and restoration of missing teeth by fixed prostheses.
    • Stability of dental implants in grafted bone in the anterior maxilla: longitudinal study.

      Al-Khaldi, Nasser; Sleeman, Duncan; Allen, Finbarr; Private Dental Practice, Muscat, Oman. (2010-06-06)
      We aimed to assess the stability over time of dental implants placed in grafted bone in the maxilla using resonance frequency analysis, and to compare the stability of implants placed in grafted and non-grafted bone. Data were collected from 23 patients (15 test and 8 controls) in whom 64 implants (Brånemark system, Nobel Biocare, Göteborg, Sweden) were placed in accordance with the two-stage surgical protocol. In the test group 36 fixtures were placed in grafted bone, and in the control group 28 fixtures were placed in non-grafted bone. Resonance frequency analysis was used to assess the test sites at implant placement and abutment connection. The mean (SD) implant stability quotient (ISQ) for test sites at the time of implant placement was 61.91 (6.68), indicating excellent primary stability, and was 63.53 (5.76) at abutment connection. ISQ values at abutment connection were similar for test and control sites. Implants placed in grafted bone compared favourably with those in non-grafted bone, and showed excellent stability.