UPFRONT

possibilities; if the restoration is replaced, it Dental research local council), and they should ensure there
is considered to have failed or the restoration are appropriate measures in place so that the
has failed when the decision to replace it was
International research collaboration safety of staff and pupils are adequate. When
based on clearly defined guidelines. Sir, the office of the International Association it comes to dental trauma and its manage-
The lack of controlled clinical trials shows for Dental Research Caribbean Section ment, it seems there is no such appropriate
the difficulties of carrying out these trials in [IADR-CS] is pleased to share the official measure in place yet.
practice and therefore, throws into question launch of its Newsletter. I have distributed a region-wide voluntary
the motivation in the decisions made by the The overall objectives are strengthening the questionnaire to all the schools in the North
practitioners who carried out the treatments mission and vision of IADR among Caribbean East, for assessment of their knowledge and
reported on in this paper. members, providing an opportunity for col- desire to seek an appropriate method of
There are several factors that contribute to laboration and the promotion and dissemina- training and advice.
prescribing patterns: tion of research activities from dentists and Post evaluation of this data, I aim to
• Undergraduate or postgraduate training specialist dentists within the region. provide a dental trauma protocol for schools
• Time available for treatments The launch of the first issue took place on and a ‘training package’ for teachers, which I
• Financial pressures 15 June 2018 at the IADR-CS meeting: the am currently constructing.
• Gender 3rd Caribbean Oral Health Initiative Summit I also plan to submit a similar letter to
• Age in Puerto Rico, USA. an education journal in the North East to
• The environment the practitioner is The contents of the newsletter include a increase awareness of my project and enthuse
working in be it general practice, hospital message from the IADR President, key events, schools to take part.
or academic. and research at Trinidad and Tobago. The full G. O’Neill, by email
text is available at https://goo.gl/XgPUQh. DOI: 10.1038/sj.bdj.2018.765
All of these will influence, more or less, the We continue to look forward to research col-
choice or preference for treatment. laboration across global dental researchers. Occlusion
Daniel Kahneman, in his book Thinking, A. B. R. Santosh, J. Collins, L. Feliz and
fast and slow2 writes: ‘The extent of consist- N. Abreu, by email
Time to debate malocclusion
ency is often a matter of concern’ and DOI: 10.1038/sj.bdj.2018.764 Sir, I believe dentistry could be at the centre
mentions how experienced radiologists who of a health revolution. There is the very
evaluate chest x-rays as ‘normal’ or ‘abnormal’ Dental trauma real possibility that simple public health
contradict themselves some of the time when measures could minimise and even eliminate
they see the picture on different occasions.
Trauma protocol for schools malocclusion, TMJ and sleep apnoea, thereby
As human beings we are not as consistent Sir, a recent case in practice has led me to improving the lives of countless individuals
or reliable as we would like to think. And carry out a service evaluation in the local and saving the NHS huge sums of money. I
how useful is this information? community – assessing the knowledge of don’t have all the answers, but I am asking the
With the patient sitting in the dental chair, the management of dental trauma amongst right questions. I want the truth, backed by
the question that confronts the dentist is ‘what school teachers in the North East. scientific evidence, so our patients can benefit.
do I do here?’ The practitioner has to make a A nine-year-old girl attended with a For a decade, I have raised concerns that
decision within the context of the patient. If complicated enamel-dentine fracture 11 and our profession treats a modern disease,
the tooth were out of the mouth and held in an uncomplicated enamel-denture fracture malocclusion, as a genetic inevitability. The
the hand the ‘best’ way to bring it to form and on the 21, which occurred during lunch time. evidence for an environmental origin is
function may be one type of treatment. She attended one hour after the incident with unambiguous. Less than 1,000 years ago, the
But, in the context of the mouth, her teacher, who was also her mother. vast majority of people gained and main-
modifying factors have to be taken into On review of the incident with the child’s tained all of their teeth in reasonable occlu-
account and the option for ‘best’ treatment mother, it was reported that there was no sions and alignment from birth to death.
may be quite different. dental emergency protocol at the school. Today, more than a third of 12-year-
The real challenge is for practitioners to A brief ‘trial’ survey distributed to the old children in the UK have an index of
be aware of all the treatment options and schools near the practice showed that on treatment need score of 3.8 or above and
how and why they arrive at the option of review of 45 responses from the teachers and permanent retention is routine.
choice and to be conscious of the question staff within these schools, there was an overall We should work together to change this by
as to whose interests are being served in the unsatisfactory knowledge of the appropri- finding definitive answers to questions such
provision of treatment. Is it the patient’s or ate management procedures and protocol a as:
the dentist’s? Hopefully, both! school could have in place to prevent, manage • Why has there been such a rapid rise in
R. Caplin, by email and treat the various dental injuries which malocclusion?
1. Burke F J T, Lucarotti P S K. The ultimate guide to
may occur during school hours. • Why do teeth become crooked in the first
restoration longevity in England and Wales. Part 5:
crowns: time to next intervention and to extraction of The Department for Education has place?
the restored tooth. Br Dent J 2018; 225: 33–48. confirmed that its current health and safety • How is TMD related to malocclusion?
2. Kahneman D. Thinking, fast and slow. p 225. Penguin
Books, 2012. requirements for schools lie in the hands of • Will root resorption affect root canal
DOI: 10.1038/sj.bdj.2018.763 the school’s owner/employer (usually the therapy?

376 BRITISH DENTAL JOURNAL | VOLUME 225 NO. 5 | SEPTEMBER 14 2018

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