For Authors | Evidence-Based Dentistry

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For Authors | British Dental Journal

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For Authors & Referees | BDJ Open

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Dens invaginatus: a clinical update and a proposed new three-dimensional classification - British Dental Journal

Dens invaginatus is a developmental anomaly characterised by enamel and dentine infolding, resulting in highly variable internal anatomy that can complicate diagnosis, treatment planning and long-term prognosis. Traditional two-dimensional classifications such as Oehler's Classification do not fully reflect the morphological complexity of invaginations which can now be evaluated with cone beam computed tomography. This paper provides an updated clinical overview of the aetiology, developmental principles, diagnostic features and key considerations for the management of dens invaginatus. A new three-dimensional classification – the Manchester Classification – is introduced which assesses the vertical extent of the invagination, its horizontal morphology and the proximity to the main canal. This classification offers a more detailed and clinically relevant representation of this anomaly, supporting more predictable diagnostic interpretation and treatment planning. Management recommendations informed by the Manchester Classification are outlined, offering structured guidance for a range of clinical presentations. The classification is intended to support clinical decision-making and bridge the gap between specialist endodontic understanding and general practice. Early recognition and three-dimensionally informed treatment planning have the potential to improve outcomes for teeth affected by dens invaginatus.

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OSRAQMUL: a digital application for oral surgery risk assessment - BDJ Open

Adherence to clinical guidelines is central to patient safety in oral surgery, yet guideline uptake in routine dental practice remains inconsistent. Traditional guideline formats, such as static PDF documents, can be difficult to navigate at the point of care. Digital decision-support tools may improve accessibility, efficiency and clinician confidence, but evidence specific to oral surgery is limited. To evaluate whether the Oral Surgery Risk Assessment (OSRA) digital application improves usability, efficiency, perceived clinical impact and user satisfaction compared with conventional PDF-based guideline access. A randomised crossover study was conducted among 30 participants from a single academic centre, including undergraduate dental students, junior dental surgeons (DFTs/DCTs) and senior clinicians. Participants used both the OSRA digital application and conventional PDF guidelines across standardised oral surgery clinical scenarios. Outcomes were assessed using a structured questionnaire covering usability, reliability and trust, efficiency and workflow, satisfaction and future use and perceived clinical impact, measured on five-point Likert scales. Paired comparisons were analysed using Wilcoxon signed-rank tests, with effect sizes reported. Qualitative free-text feedback was analysed thematically. Across all domains, the OSRA application was consistently rated higher than PDF guidelines (all p < 0.05), with large to very large effect sizes (r = 0.55–0.75). The greatest differences were observed for efficiency and workflow (r = 0.75) and satisfaction and future use (r = 0.73). Participants reported reduced cognitive load, faster access to guidance and greater confidence in clinical decision making when using the app. Reliability analysis demonstrated excellent internal consistency for app-based ratings (Cronbach’s α = 0.96). Qualitative feedback highlighted clarity, intuitive navigation and workflow integration as key strengths, alongside requests for enhanced transparency of evidence sources and expanded functionality. In this pilot study, the OSRA digital application outperformed conventional PDF guidelines across all evaluated domains, suggesting that digital, point of care decision support tools can improve guideline accessibility, efficiency and user experience in oral surgery. With further development and validation, such tools have the potential to support safer, more consistent evidence-based clinical practice.

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Exploring the shared genetic architecture between periodontitis and cardiovascular disease - BDJ Open

Epidemiological evidence supports the association between periodontitis and cardiovascular diseases (CVD); however, their shared genetic mechanisms remain inadequately defined. This study elucidates their genetic architecture by identifying shared risk loci and associated genes. This study employs Mendelian randomization (MR) to investigate bidirectional causal relationships between periodontitis and five types of CVD based on genome-wide association study (GWAS) summary data. Cross-trait analyses were applied to examine genetic correlations across trait pairs, identifying pleiotropic loci and associated genes. Functional annotation and tissue-specificity analyses elucidate their biological functions. Bidirectional and multivariable MR analyses confirmed that the association between CVD and periodontitis is not driven by a direct causal relationship. Additionally, the genetic correlation between these disorders underscores the importance of investigating their shared genomic architecture. Colocalization analysis identified significant shared causal variants at loci 4p14 and 15q25.1. At the gene level, seven unique pleiotropic genes (e.g., CD151, POLR2L, and HLA-DQA1) were annotated. Pathway analysis revealed that these genetic architectures likely mediate cross-disease interactions through an inflammation-metabolism regulatory axis (Inflammatory Response and Cholesterol Metabolism Pathway). Tissue enrichment analyses demonstrated that pleiotropic signals, from SNP to gene levels, were significantly enriched in immune-related tissues and disease-relevant sites like the heart. This study reveals a shared genetic basis between periodontitis and five types of CVD, suggesting potential underlying mechanisms. However, based on summary-level data, it remains unclear whether this association represents direct biological genetic determinants or indirect pathways mediated by shared environmental or behavioral risk factors. Future studies utilizing individual-level data with covariate adjustments are needed to further investigate these relationships.

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Strategies to enable workplaces to support autistic clinicians in the dental workforce: learnings from the Buckland Review of Autism Employment - British Dental Journal

Embracing neurodiversity in the workplace can enhance productivity, job satisfaction, and ultimately create a more compassionate and effective healthcare environment. This can positively impact the wider dental team and overall patient care. Autistic individuals often encounter unique challenges in the workplace, particularly in fields like dentistry. This article focuses on the experiences of autistic dental clinicians, highlighting the barriers they face in employment and the potential need for reasonable adjustments in the workplace. Evidence such as the 2024 Buckland Review of Autism Employment emphasise that autistic adults often experience challenges securing and maintaining employment due to an absence of understanding and support. Legislations such as the Equality Act 2010, and other initiatives, including the Disability Confident Scheme and the Autistica Neurodiversity Employer Index, can protect autistic people in the workplace and help to overcome barriers. By implementing personalised adjustments specific to the individual needs of an autistic employee, such as sensory accommodations, flexible routines, and mentorship programmes, dental practices can cultivate a more inclusive environment. This article draws attention to the need for a dynamic shift towards valuing the unique strengths of autistic clinicians and integrating them into a diverse and equitable dental community.

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BDJ Open – the BDJ Portfolio's fully open access, international research journal

British Dental Journal - BDJ Open – the BDJ Portfolio's fully open access, international research journal

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