University Dental Hospital of Manchester

The aim of this study was to develop a valid and reproducible index of orthodontic treatment priority. After reviewing the available literature, it was felt that this could be best achieved by using two separate components to record firstly the dental health and functional indications for treatment, and secondly the aesthetic impairment caused by the malocclusion. A modification of the index used by the Swedish Dental Health Board was used to record the need for orthodontic treatment on dental health and functional grounds. This index was modified by defining five grades, with precise dividing lines between each grade. An illustrated 10-point scale was used to assess independently the aesthetic treatment need of the patients. This scale was constructed using dental photographs of 12-year-olds collected during a large multi-disciplinary survey. Six non-dental judges rated these photographs on a visual analogue scale, and at equal intervals along the judged range, representative photographs were chosen. To test the index in use, two sample populations were defined; a group of patients referred for treatment, and a random sample of 11-12-year-old schoolchildren. Both samples were examined using the index and satisfactory levels of intra- and inter-examiner agreement were obtained.

Abstract Objective: To determine the validity of adjusted indirect comparisons by using data from published meta-analyses of randomised trials. Design: Direct comparison of different interventions in randomised trials and adjusted indirect comparison in which two interventions were compared through their relative effect versus a common comparator. The discrepancy between the direct and adjusted indirect comparison was measured by the difference between the two estimates. Data sources: Database of abstracts of reviews of effectiveness (1994-8), the Cochrane database of systematic reviews, Medline, and references of retrieved articles. Results: 44 published meta-analyses (from 28 systematic reviews) provided sufficient data. In most cases, results of adjusted indirect comparisons were not significantly different from those of direct comparisons. A significant discrepancy (P<0.05) was observed in three of the 44 comparisons between the direct and the adjusted indirect estimates. There was a moderate agreement between the statistical conclusions from the direct and adjusted indirect comparisons (κ 0.51). The direction of discrepancy between the two estimates was inconsistent. Conclusions: Adjusted indirect comparisons usually but not always agree with the results of head to head randomised trials. When there is no or insufficient direct evidence from randomised trials, the adjusted indirect comparison may provide useful or supplementary information on the relative efficacy of competing interventions. The validity of the adjusted indirect comparisons depends on the internal validity and similarity of the included trials. What is already known on this topic Many competing interventions have not been compared in randomised trials Indirect comparison of competing interventions has been carried out in systematic reviews, often implicitly Indirect comparison adjusted by a common control can partially take account of prognostic characteristics of patients in different trials What this study adds Results of adjusted indirect comparison usually, but not always, agree with those of head to head randomised trials The validity of adjusted indirect comparisons depends on the internal validity and similarity of the trials involved

In order that health service resources are allocated in the way which most benefits the population, systematic review of the available evidence regarding the effectiveness of programmes and interventions are required. This study examined papers relating to dental health education interventions, which were published between 1982 and 1994 (n = 143). Each was scored by two independent researchers according to twenty predetermined validity criteria. For each paper which achieved a validity score of more than 12 (n = 37), data concerning the objectives of the intervention, the types and numbers of participants, and the outcomes, were extracted from the article. Where sufficient data were provided in a paper which met more than 15 of the validity criteria quantitative meta-analysis was carried out i.e. the results of the studies were pooled in order to calculate an overall intervention effect with confidence intervals. This combination of qualitative and quantitative review techniques showed that dental health interventions have: a small positive, but temporary effect on plaque accumulation (reduction in plaque index = 0.37 95% CI -0.29-0.59); no discernible effect on caries increment and a consistent positive effect on knowledge levels. The results of this analysis suggest that further efforts to synthesise current information about dental health education, in a systematic way, are required, along with maintenance of rigorous scientific standards in evaluation research.

Affymetrix U133plus2 GeneChips were used to profile 59 head and neck squamous cell cancers. A hypoxia metagene was obtained by analysis of genes whose in vivo expression clustered with the expression of 10 well-known hypoxia-regulated genes (e.g., CA9, GLUT1, and VEGF). To minimize random aggregation, strongly correlated up-regulated genes appearing in >50% of clusters defined a signature comprising 99 genes, of which 27% were previously known to be hypoxia associated. The median RNA expression of the 99 genes in the signature was an independent prognostic factor for recurrence-free survival in a publicly available head and neck cancer data set, outdoing the original intrinsic classifier. In a published breast cancer series, the hypoxia signature was a significant prognostic factor for overall survival independent of clinicopathologic risk factors and a trained profile. The work highlights the validity and potential of using data from analysis of in vitro stress pathways for deriving a biological metagene/gene signature in vivo.

UNLABELLED: The sensitivity and specificity of a test cannot be used to estimate probability of disease in individual patients. They can, however, be combined into a single measure called the likelihood ratio which is, clinically, more useful than sensitivity or specificity. Likelihood ratios provide a summary of how many times more (or less) likely patients with a disease are to have a particular result than patients without the disease. Using the principles of the Bayes theorem, likelihood ratios can be used in conjunction with pre-test probability of disease to estimate an individual's post-test probability of disease, that is his or her chance of having disease once the result of a test is known. The Fagan's nomogram is a graphical tool which, in routine clinical practice, allows one to combine the likelihood ratio of a test with a patient's pre-test probability of disease to estimate post-test probability. CONCLUSION: Likelihood ratios summarize information about a diagnostic test by combining sensitivity and specificity. The Fagan's nomogram is a useful and convenient graphical tool that allows likelihood ratios to be used in conjunction with a patient's pre-test probability of disease to estimate the post-test probability of disease.

OBJECTIVE: To examine the quality of oral health promotion research evidence and to assess the effectiveness of health promotion, aimed at improving oral health using a systematic and scientifically defensible methodology. BASIC RESEARCH DESIGN: Systematic review of oral health promotion research evidence using electronic searching, iterative hand-searching, critical appraisal and data synthesis. CLINICAL SETTING: The settings of the primary research reviewed were clinical, community, schools or other institutions. The participants were children, the elderly, adults and people with handicaps and disabilities. INTERVENTIONS: Only studies which reported an evaluative component were included. Theoretical and purely descriptive papers were excluded. MAIN OUTCOME MEASURES: The review examined the evidence of effectiveness of oral health promotion on caries, oral hygiene, oral health related knowledge, attitudes and behaviours. RESULTS: Very few definitive conclusions about the effectiveness of oral health promotion can be drawn from the currently available evidence. Caries and periodontal disease can be controlled by regular toothbrushing with a fluoride toothpaste but a cost-effective method for reliably promoting such behaviour has not yet been established. Knowledge levels can almost always be improved by oral health promotion initiatives but whether these shifts in knowledge and attitudes can be causally related to changes in behaviour or clinical indices of disease has also not been established. CONCLUSIONS: Oral health promotion which brings about the use of fluoride is effective for reducing caries. Chairside oral health promotion has been shown to be effective more consistently than other methods of health promotion. Mass media programmes have not been shown to be effective. The quality of oral health promotion evaluation research needs to be improved.

Abstract Objective: To assess the effect of reduction or modification of dietary fat intake on total and cardiovascular mortality and cardiovascular morbidity. Design: Systematic review. Data sources: Cochrane Library, Medline, Embase, CAB abstracts, SIGLE, CVRCT registry, and biographies were searched; trials known to experts were included. Included studies: Randomised controlled trials stating intention to reduce or modify fat or cholesterol intake in healthy adult participants over at least six months. Inclusion decisions, validity, and data extraction were duplicated. Meta-analysis (random effects methodology), meta-regression, and funnel plots were performed. Results: 27 studies (30 902 person years of observation) were included. Alteration of dietary fat intake had small effects on total mortality (rate ratio 0.98; 95% confidence interval 0.86 to 1.12). Cardiovascular mortality was reduced by 9% (0.91; 0.77 to 1.07) and cardiovascular events by 16% (0.84; 0.72 to 0.99), which was attenuated (0.86; 0.72 to 1.03) in a sensitivity analysis that excluded a trial using oily fish. Trials with at least two years' follow up provided stronger evidence of protection from cardiovascular events (0.76; 0.65 to 0.90). Conclusions: There is a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat intake, seen particularly in trials of longer duration. What is already known on this topic The epidemiological relation between dietary fat intake and cardiovascular disease is central in strategies aimed at risk reduction in populations and individuals Systematic review of randomised controlled trials supports manipulation of dietary fat to control serum lipid concentrations, though evidence of effect on one risk factor does not rule out an opposite or reinforced effect on another unstudied risk factor Randomised controlled trials of dietary fat reduction or modification have shown varying results on cardiovascular morbidity and mortality What this study adds Systematic review of trials of modified fat intake shows that reduction or modification of dietary fat intake results in reductions in cardiovascular events, but only in trials of at least two years' duration There is little effect on total mortality Despite decades of effort and many thousands of people randomised, there is still only limited and inconclusive evidence of the effects of modification of total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality

STUDY OBJECTIVE: To determine the prevalence of oro-facial pain (OFP) in the population and within-population subgroups and to describe the associated disability. DESIGN: Cross-sectional population study. SETTING: General medical practice in South East Cheshire, United Kingdom. PARTICIPANTS: A random sample of 4000 adults aged 18-65 years of whom 2504 responded (adjusted participation rate 74%). MAIN RESULTS: The overall prevalence of OFP was 26% (95% Confidence Interval (CI) 24%, 28%). The prevalence of symptoms was higher in women (30%) than in men (21%) and in both sexes the highest (30%) prevalence was found in the 18-25 year age group and the lowest (22%) in the 56-65 age group. Of all the participants, 12% had pain in or around the eyes, 10% reported pain in and around the temples, 6% pain in front of the ears and 6% pain in the jaw joints. Only 46% of the participants with OFP had sought professional advice from a dentist or general medical practitioner and 17% had to take time off work or were unable to carry out normal activities because of pain. CONCLUSIONS: OFP is a common symptom experienced by a quarter of the adult population, of whom only 46% seek treatment. The prevalence is higher in women and younger age groups.

Artificial intelligence (AI) is rapidly transforming the healthcare and medical and dental education sectors. With advancements in AI technology and its integration into routine tasks, the field of healthcare and education is rapidly evolving. This article aims to provide an in-depth analysis of the impact of AI in these sectors and to discuss the advantages and disadvantages of its integration. The article will begin by examining the use of AI in healthcare, including its impact on patient care, diagnosis and treatment, and the benefits it brings to medical professionals and patients alike. The article will then delve into the use of AI in medical and dental education, exploring its impact on student learning and teaching practices, and the benefits and challenges it presents for educators and students. Additionally, this article will also cover the impact of AI on the publishing of scientific articles in journals. With the increasing volume of submissions and the need for more efficient management, AI is being utilised to streamline the peer-review process and improve the quality of peer-review. The article will also delve into the possibility of AI enabling new forms of publication and supporting reproducibility, helping to improve the overall quality of scientific publications. Furthermore, the authors of this article have written it using AI, making it a landmark paper that showcases the true technological power of AI in the field of writing.

OBJECTIVE: To assess the long term effects of advice to restrict dietary sodium in adults with and without hypertension. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Cochrane library, Medline, Embase, and bibliographies. STUDY SELECTION: Unconfounded randomised trials that aimed to reduce sodium intake in healthy adults over at least 6 months. Inclusion decisions, validity and data extraction were duplicated. Random effects meta-analysis, subgrouping, sensitivity analysis, and meta-regression were performed. OUTCOMES: Mortality, cardiovascular events, blood pressure, urinary sodium excretion, quality of life, and use of antihypertensive drugs. RESULTS: Three trials in normotensive people (n=2326), five trials in those with untreated hypertension (n=387), and three trials in people being treated for hypertension (n=801) were included, with follow up from six months to seven years. The large high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported. There were 17 deaths, equally distributed between intervention and control groups. Systolic and diastolic blood pressures were reduced (systolic by 1.1 mm Hg, 95% confidence interval 1.8 to 0.4 mm Hg; diastolic by 0.6 mm Hg, 1.5 to -0.3 mm Hg) at 13 to 60 months, as was urinary 24 hour sodium excretion (by 35.5 mmol/24 hours, 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. CONCLUSIONS: Intensive interventions, unsuited to primary care or population prevention programmes, provide only small reductions in blood pressure and sodium excretion, and effects on deaths and cardiovascular events are unclear. Advice to reduce sodium intake may help people on antihypertensive drugs to stop their medication while maintaining good blood pressure control.

OBJECTIVES: To develop "basic principles" on the use of dental cone beam CT by consensus of the membership of the European Academy of Dental and Maxillofacial Radiology. METHODS: A guideline development panel was formed to develop a set of draft statements using existing European directives and guidelines on radiation protection. These statements were revised after an open debate of attendees at a European Academy of Dental and Maxillofacial Radiology (EADMFR) Congress in June 2008. A modified Delphi procedure was used to present the revised statements to the EADMFR membership, utilising an online survey in October/November 2008. RESULTS: Of the 339 EADMFR members, 282 had valid e-mail addresses and could be alerted to the online survey. A response rate of 71.3% of those contacted by e-mail was achieved. Consensus of EADMFR members, indicated by high level of agreement for all statements, was achieved without a need for further rounds of the Delphi process. CONCLUSIONS: A set of 20 basic principles on the use of dental cone beam CT has been devised. They will act as core standards for EADMFR and, it is hoped, will be of value in national standard-setting within Europe.

The purpose of this manuscript is to discuss the current available methods to detect early lesions amenable to prevention. The current evidenced-based caries understanding, based on biological concepts, involves new approaches in caries detection, assessment, and management that should include non-cavitated lesions. Even though the importance of management of non-cavitated (NC) lesions has been recognized since the early 1900 s, dental caries has been traditionally detected at the cavitation stage, and its management has focused strongly on operative treatment. Methods of detection of early carious lesions have received significant research attention over the last 20 years. The most common method of caries detection is visual-tactile. Other non-invasive techniques for detection of early caries have been developed and investigated such as Quantitative Light-induced Fluorescence (QLF), DIAGNOdent (DD), Fibre-optic Transillumination (FOTI) and Electrical Conductance (EC). Based on previous systematic reviews, the diagnosis of NCCLs might be more accurately achieved in combination of the visual method and the use of other methods such as electrical methods and QLF for monitoring purposes.

The hereditary dentine disorders, dentinogenesis imperfecta (DGI) and dentine dysplasia (DD), comprise a group of autosomal dominant genetic conditions characterised by abnormal dentine structure affecting either the primary or both the primary and secondary dentitions. DGI is reported to have an incidence of 1 in 6,000 to 1 in 8,000, whereas that of DD type 1 is 1 in 100,000. Clinically, the teeth are discoloured and show structural defects such as bulbous crowns and small pulp chambers radiographically. The underlying defect of mineralisation often results in shearing of the overlying enamel leaving exposed weakened dentine which is prone to wear. Currently, three sub-types of DGI and two sub-types of DD are recognised but this categorisation may change when other causative mutations are found. DGI type I is inherited with osteogenesis imperfecta and recent genetic studies have shown that mutations in the genes encoding collagen type 1, COL1A1 and COL1A2, underlie this condition. All other forms of DGI and DD, except DD-1, appear to result from mutations in the gene encoding dentine sialophosphoprotein (DSPP), suggesting that these conditions are allelic. Diagnosis is based on family history, pedigree construction and detailed clinical examination, while genetic diagnosis may become useful in the future once sufficient disease-causing mutations have been discovered. Differential diagnoses include hypocalcified forms of amelogenesis imperfecta, congenital erythropoietic porphyria, conditions leading to early tooth loss (Kostmann's disease, cyclic neutropenia, Chediak-Hegashi syndrome, histiocytosis X, Papillon-Lefevre syndrome), permanent teeth discolouration due to tetracyclines, Vitamin D-dependent and vitamin D-resistant rickets. Treatment involves removal of sources of infection or pain, improvement of aesthetics and protection of the posterior teeth from wear. Beginning in infancy, treatment usually continues into adulthood with a number of options including the use of crowns, over-dentures and dental implants depending on the age of the patient and the condition of the dentition. Where diagnosis occurs early in life and treatment follows the outlined recommendations, good aesthetics and function can be obtained.

BACKGROUND: Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. OBJECTIVES: To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. SEARCH METHODS: In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. SELECTION CRITERIA: Only randomised controlled trials were eligible for inclusion. DATA COLLECTION AND ANALYSIS: We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. MAIN RESULTS: This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small. AUTHORS' CONCLUSIONS: Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

One hundred and fifteen frontal and profile photographs of the nasolabial area of subjects with complete unilateral clefts of the lip and palate from six European centers were assessed. Four components of the nasolabial area were rated separately by a panel of judges using a five-point scale of attractiveness. The Tukey multiple comparison test showed significant differences between the centers. The relative position of the six centers in this study followed a similar pattern to their respective positions in the cephalometric and dental cast studies.

OBJECTIVES: To determine the degree of psychological distress, the experience of emotional exhaustion, and the extent of stress associated with course work in dental students and to compare these measurements among seven European dental schools. DESIGN: Multi-centred survey. SETTING: Dental Schools at Amsterdam, Belfast, Cork, Greifswald, Helsinki, Liverpool and Manchester. PARTICIPANTS: 333 undergraduate first-year dental students. MEASURES: General Health Questionnaire (GHQ12), Maslach Burnout Inventory (MBI), Dental Environment Stress Questionnaire (DES), demographic variables. PROCEDURE: Questionnaire administered to all students attending first year course. Completed questionnaires sent to central office for processing. RESULTS: Seventy-nine percent of the sampled students responded. Over a third of the students (36%) reported significant psychological distress (morbidity) at the recommended cut-off point (>3 on GHQ). These scores were similar to those reported for medical undergraduates. Twenty-two percent recorded comparatively high scores on emotional exhaustion. A wide variation in these 2 measurements was found across schools (p's<0.001). Stress levels indicated by the DES were less variable (p>0.5). Some evidence showed that contact with patients and the level of support afforded by living at home may be protective. CONCLUSION: Higher than expected levels of emotional exhaustion were found in a large sample of first-year undergraduate dental students in Europe.

OBJECTIVES: To assess the effectiveness of five gastroprotective strategies for people taking non-steroidal anti-inflammatory drugs (NSAIDs)--H2 receptor antagonists plus non-selective (or cyclo-oxygenase-1) NSAIDs; proton pump inhibitors plus non-selective NSAIDs; misoprostol plus non-selective NSAIDs; COX-2 selective NSAIDs; or COX-2 specific NSAIDs--in reducing serious gastrointestinal complications, symptomatic ulcers, serious cardiovascular or renal disease, and deaths, and improving quality of life. DATA SOURCES: The Cochrane Library, Medline, Embase, Current Controlled Trials, and System for Information on Grey Literature in Europe (SIGLE) were searched to May 2002. Bibliographies and author contacts were used to identify further studies; non-English articles were included. REVIEW METHODS: Trial selection, data extraction, and quality assessment were performed independently, in duplicate. Articles were rejected only if the study was not a randomised controlled trial; did not assess a gastroprotective strategy versus placebo; included exclusively children or healthy volunteers; lasted less than 21 days; or no review outcomes were measured. Quality assessment included allocation concealment and baseline similarity. Random effects meta-analysis, meta-regression and subgrouping were used to pool effects and analyse associations with length of follow up, mean age, and baseline gastrointestinal status. Heterogeneity was examined and sensitivity analyses performed. RESULTS: Of 112 included randomised controlled trials (74 666 participants), five were judged to be at low risk of bias, and 138 deaths and 248 serious gastrointestinal events were reported overall. On comparing gastroprotective strategies versus placebo we found no evidence of effectiveness of H2 receptor antagonists for any primary outcomes (few events reported); proton pump inhibitors may reduce the risk of symptomatic ulcers (relative risk 0.09, 95% confidence interval 0.02 to 0.47); misoprostol reduces the risk of serious gastrointestinal complications (0.57, 0.36 to 0.91) and symptomatic ulcers (0.36, 0.20 to 0.67); COX-2 selectives reduce the risk of symptomatic ulcers (0.41, 0.26 to 0.65) and COX-2 specifics reduce the risk of symptomatic ulcers (0.49, 0.38 to 0.62) and possibly serious gastrointestinal complications (0.55, 0.38 to 0.80). All strategies except COX-2 selectives reduce the risk of endoscopic ulcers (at least 3 mm in diameter). CONCLUSIONS: Misoprostol, COX-2 specific and selective NSAIDs, and probably proton pump inhibitors significantly reduce the risk of symptomatic ulcers, and misoprostol and probably COX-2 specifics significantly reduce the risk of serious gastrointestinal complications, but data quality is low. More data on H2 receptor antagonists and proton pump inhibitors are needed, as is better reporting of rare but important outcomes.

BACKGROUND: We have previously shown that the menstrual cycle has no effect on rectal sensitivity of normal healthy women, despite them having looser stools at the time of menses. Patients with irritable bowel syndrome (IBS) often report significant exacerbation of their IBS symptoms with menses, raising the possibility that IBS patients may respond differently to the menstrual cycle. AIM AND METHODS: Rectal responses to balloon distension during days 1-4 (menses), 8-10 (follicular phase), 18-20 (luteal phase), and 24-28 (premenstrual phase) of the menstrual cycle were assessed in 29 female IBS patients (aged 21-44 years), diagnosed by the Rome I criteria. During the course of the study patients completed symptom diaries to assess abdominal pain and bloating (visual analogue scale), and frequency and consistency of bowel habits. In addition, levels of anxiety and depression were assessed using the hospital anxiety and depression questionnaire. RESULTS: Menses was associated with a worsening of abdominal pain and bloating compared with most other phases of the menstrual cycle (p<0.05). Bowel habits also became more frequent (p<0.05) and patients tended to have a lower general well being. Rectal sensitivity increased at menses compared with all other phases of the cycle (p<0.05). There was no associated change in rectal compliance, wall tension, or motility index. Neither was there any difference in resting anal pressure or the distension volumes required to relax the internal anal sphincter during the menstrual cycle. CONCLUSION: These data (1) confirm that IBS symptomatology is exacerbated at menses and (2) show for the first time that in contrast with healthy women, rectal sensitivity changes with the menstrual cycle. These cyclical changes in sensitivity suggest that women with IBS respond differently to fluctuations in their sex hormonal environment or its consequences compared with healthy females.

The aims of this study were to evaluate (i) the effect of ethnicity, social deprivation, and normative orthodontic treatment need on orthodontic aesthetic self-perception, self-perceived need for orthodontic treatment, and oral aesthetic impact of malocclusion; (ii) the effect of ethnicity, social deprivation, and gender on perceived orthodontic treatment need and use of orthodontic services; (iii) the influence of perceived oral aesthetic impact of malocclusion on perceived need and wish for orthodontic treatment; and (iv) whether orthodontic treatment experience influences perceived oral aesthetic impact of malocclusion. A stratified, random sample of 434 14-15-year-old children from schools in Manchester, UK, was obtained. Information was collected on orthodontic aesthetic self-perception and orthodontic treatment experience using a questionnaire. The former data were combined to form an Oral Aesthetic Subjective Impact Scale (OASIS). Normative orthodontic treatment need was measured with the Index of Orthodontic Treatment Need (IOTN). Children with higher clinical need for orthodontic treatment perceived themselves as worse off than their peers with lower need. More socially deprived children or those with high IOTN aesthetic component (AC) scores had a higher (i.e. more negative) aesthetic impact (OASIS) score. Asians and females had higher IOTN dental health component (DHC) scores, but a better aesthetic appearance than Caucasians and males. More deprived children were less likely to have received orthodontic treatment. Despite this, OASIS scores were similar between treated and untreated children. Untreated children who wished for orthodontic treatment had higher IOTN AC and OASIS scores.

AIM: To determine the resistance of microorganisms associated with refractory endodontic infections to sodium hypochlorite used as a root canal irrigant. METHODOLOGY: Two strains each of Actinomyces naeslundii, Candida albicans and Enterococcus faecalis were tested as late logarithmic phase inocula, against sodium hypochlorite adjusted to 0.5, 1.0, 2.5 and 5.25% w/v. Contact times used were 0, 10, 20, 30, 60 and 120 s. In the case of E. faecalis, additional experiments used contact times of 1.0, 2.0, 5.0, 10.0 and 30.0 min. Anti-microbial action was halted by sodium thiosulphate addition. Survivors were measured primarily using viable counts on drop plates. Additionally, pour plates were used to count low colony-forming units (cfu) and dilutions to 10(-6) were used to count high cfu. RESULTS: All concentrations of NaOCl lowered cfu below the limit of detection after 10 s in the case of A. naeslundii and C. albicans. However, E. faecalis proved to be more resistant to NaOCl. Using 0.5% NaOCl for 30 min reduced cfu to zero for both strains tested. This compares with 10 min for 1.0%, 5 min for 2.5% and 2 min for 5.25% (P < 0.001). Regression analysis for the dependent variable log(e)(count + 1) with log(e)(time + 1) and concentration as explanatory variables gave rise to a significant interaction between time and concentration (P < 0.001). CONCLUSION: The published association of E. faecalis with refractory endodontic infection may result, at least partially, from high resistance of this species to NaOCl. This does not appear to be the case with A. naeslundii or C. albicans.