Technological Innovations in the Restorative Department at the University of Tennessee College of Dentistry

The UT College of Dentistry has been one of the leaders in the introduction of the CAD/CAM delivery of dentistry to the dental students. The integration of technology into a dental school curriculum requires a change in thinking and a modification of the curriculum in order to introduce it to the present day students This article updates the integration of the CEREC system into the UT Dental School curriculum, discussing the changes in equipment and teaching techniques since the last article in 2012.

Creating a new generation of pediatric dentists: a paradigm shift in training

The University of California, Los Angeles (UCLA) School of Dentistry has implemented a Health Resources and Services Administration-funded program to prepare dentists for the complex and comprehensive needs of pediatric patients within rapidly changing demographics and a paradigm shift in dentistry. Traditional dental education has focused on how to respond to oral disease, whereas UCLA's program shifts the paradigm to emphasize early assessment, risk-based prevention, and disease management. A holistic approach to dental care that considers social and environmental determinants is used with minimally invasive techniques for restorative care. To support this change, pediatric dental residents receive traditional training combined with new didactics, advocacy opportunities, and applied learning experiences at community-based organizations. These new elements teach residents to recognize the causal factors of disease and to identify interventions that promote oral health at the individual, family, community, and policy level. Consequently, they are better prepared to treat a diverse group of patients who historically have faced the greatest burden of disease as well as an increased number of barriers to accessing oral health care; these consist of low-income, minority, and/or pediatric populations including children with special health needs. The program's ultimate goal is for residents to deploy these skills in treating vulnerable populations and to demonstrate greater interest in collaborating with non-dental health providers and community organizations to increase access to dental services in private or public health practice settings.

Dental students' self-assessment of operative preparations using CAD/CAM: a preliminary analysis

The Commission on Dental Accreditation (CODA)'s accreditation standards for dental schools state that "graduates must demonstrate the ability to self-assess." Therefore, dental schools have developed preclinical and clinical self-assessment (SA) protocols aimed at fostering a reflective process. This study comparing students' visual SA with students' digital SA and with faculty assessment was designed to test the hypothesis that higher agreement would occur when utilizing a digital evaluation. Twenty-five first-year dental students at one dental school participated by preparing a mesial occlusal preparation on tooth #30 and performing both types of SAs. A faculty evaluation was then performed both visually and digitally using the same evaluation criteria. The Kappa statistic was used to measure agreement between evaluators. The results showed statistically significant moderate agreement between the faculty visual and faculty digital modes of evaluation for occlusal shape (K=0.507, p=0.002), proximal shape (K=0.564, p=0.001), orientation (K=0.425, p=0.001), and definition (K=0.480, p=0.001). There was slight to poor agreement between the student visual and faculty visual assessment, except for preparation orientation occlusal shape (K=0.164, p=0.022), proximal shape (K=-0.227, p=0.032), orientation (K=0.253, p=0.041), and definition (K=-0.027, p=0.824). This study showed that the students had challenges in self-assessing even when using CAD/CAM and the digital assessment did not improve the amount of student/faculty agreement.

Changing the education paradigm in pediatric dentistry

Traditional curricula of pediatric dental residency programs have overemphasized restorative dentistry while failing to give adequate attention to early diagnosis, preventive disease management, risk assessment, cultural competency, advocacy, community partnerships and interprofessional education. The University of California, Los Angeles, Community Health and Advocacy Training Program in Pediatric Dentistry emphasizes these lesser-taught areas, integrating them within a structured education in classical restorative techniques and Commission on Dental Accreditation-approved standards, providing a diverse curriculum and preparing residents for practice in increasingly diverse communities.

Using dental students' preclinical performance as an indicator of clinical success

The purpose of this study was to evaluate part of one dental school's predoctoral curriculum by investigating correlations between students' final grades in two preclinical courses and their performance in the related clinical courses. The sample consisted of 301 students at Tufts University School of Dental Medicine who graduated in 2010 and 2011. All final grades used as data were obtained from the Registrar's Office and evaluated anonymously. The average preclinical final grades differed significantly for students in the 2010 (M=84.92, SD=3.35) and 2011 (M=79.67, SD=4.67) classes, as did their average clinical final grades (2010: M=88.38, SD=2.13; 2011: M=87.45, SD=2.06). The data for each class were therefore examined separately. Results showed that the correlation between students' preclinical grades and clinical grades in operative dentistry and fixed prosthodontics was statistically significant (2010: r(2)=0.144, p<0.001; 2011: r(2)=0.261, p<0.001). This finding suggests there may be a positive relationship between preclinical and clinical performance of these students; however, the discrete factors contributing to that relationship were not investigated in this study and require further research.

Advanced predoctoral implant program at UIC: description and qualitative analysis

Dental implant education has increasingly become an integral part of predoctoral dental curricula. However, the majority of implant education emphasizes the restorative aspect as opposed to the surgical. The University of Illinois at Chicago College of Dentistry has developed an Advanced Predoctoral Implant Program (APIP) that provides a select group of students the opportunity to place implants for single-tooth restorations and mandibular overdentures. This article describes the rationale, logistics, experiences, and perspectives of an innovative approach to provide additional learning experiences in the care of patients with partial and complete edentulism using implant-supported therapies. Student and faculty perspectives on the APIP were ascertained via focus group discussions and a student survey. The qualitative analysis of this study suggests that the select predoctoral dental students highly benefited from this experience and intend to increase their knowledge and skills in implant dentistry through formal education following graduation. Furthermore, the survey indicates that the APIP has had a positive influence on the students' interest in surgically placing implants in their future dental practice and their confidence level in restoring and surgically placing implants.

Performance of dental students versus prosthodontics residents on a 3D immersive haptic simulator

This study evaluated the performance of dental students versus prosthodontics residents on a simulated caries removal exercise using a newly designed, 3D immersive haptic simulator. The intent of this study was to provide an initial assessment of the simulator's construct validity, which in the context of this experiment was defined as its ability to detect a statistically significant performance difference between novice dental students (n=12) and experienced prosthodontics residents (n=14). Both groups received equivalent calibration training on the simulator and repeated the same caries removal exercise three times. Novice and experienced subjects' average performance differed significantly on the caries removal exercise with respect to the percentage of carious lesion removed and volume of surrounding sound tooth structure removed (p<0.05). Experienced subjects removed a greater portion of the carious lesion, but also a greater volume of the surrounding tooth structure. Efficiency, defined as percentage of carious lesion removed over drilling time, improved significantly over the course of the experiment for both novice and experienced subjects (p<0.001). Within the limitations of this study, experienced subjects removed a greater portion of carious lesion on a 3D immersive haptic simulator. These results are a first step in establishing the validity of this device.

Using tablet technology and instructional videos to enhance preclinical dental laboratory learning

The purpose of this pilot study was to examine if tablet technology with accompanying instructional videos enhanced the teaching and learning outcomes in a preclinical dental laboratory setting. Two procedures deemed most challenging in Operative Dentistry II were chosen for the development of instructional videos. A random sample of thirty students was chosen to participate in the pilot. Comparison of faculty evaluations of the procedures between the experimental (tablet) and control (no tablet) groups resulted in no significant differences; however, there was a trend toward fewer failures in the experimental group. Examination of the ability to accurately self-assess was compared by exploring correlations between faculty and student evaluations. While correlations were stronger in the experimental group, the control group had significant correlations for all three procedures, while the experimental group had significant correlations on only two of the procedures. Students strongly perceived that the tablets and videos helped them perform better and more accurately self-assess their work products. Students did not support requiring that they purchase/obtain a specific brand of technology. As a result of this pilot study, further development of ideal and non-ideal videos are in progress, and the school will be implementing a "Bring Your Own Device" policy with incoming students.

Students' clinical learning in an emerging dental school: an investigation in international collaboration between Michigan and Ghana

The dearth of dental faculty members is a widely known problem that is exacerbated in countries that are attempting to begin dental education programs. This collaboration between Kwame Nkrumah University of Science and Technology and the University of Michigan investigated if dental students who have just started their clinical dental education can learn the knowledge and skills required for identifying and restoring cavitated caries lesions through compact course delivery. There were three instructional blocks: 1) didactic seminar; 2) seminar, simulated hands-on skills instruction, and clinical observation/assisting with treatment of schoolchildren; and 3) seminar, simulated skills training, and application to schoolchildren. Each dental student completed a questionnaire measuring knowledge and perceptions of knowledge, experience, and confidence at five points in time. The dental students' knowledge increased significantly as well as their perceived knowledge, experience, and confidence (p<0.0001). In general, the students showed proficiency in delivering simple treatments. The project showed that an integrated compact course delivery model may assist emerging dental schools to cope with the challenging shortage of resident faculty members.

A complex haptic exercise to predict preclinical operative dentistry performance: a retrospective study

A reliable test of manual dexterity could potentially have utility in dental education. Recently, haptic technologies have emerged that may offer a means of testing manual dexterity in the preclinical setting. The purpose of this study was to determine whether performance on a complex haptic simulator exercise was associated with preclinical operative dentistry practical examination scores or the Perceptual Ability Test (PAT) scores of the Dental Admission Test. All thirty-nine first-year dental students enrolled in the Operative Dentistry preclinical course at the Stony Brook University School of Dental Medicine completed a haptic exercise consisting of a single manual dexterity test (D-circle), repeated eight times in succession during a single session at midterm. A score reflecting accuracy and time to completion of each trial was calculated automatically and resulted in a success or failure for each trial. Preclinical operative dentistry practical examinations consisting of plastic tooth preparations given at three time points during the course were scored by four calibrated and masked course faculty members. Examination scores were compared with students' performance on the haptic test using linear regression. Number of failures during a single session on a complex haptic exercise was found to be a significant predictor of examination performance in the preclinical setting. These results suggest a role for haptics in identifying students with potential learning challenges in the preclinical stages of dental education. Identification of students with manual dexterity problems at an early stage may allow for early intervention to prevent failure.

Teaching atraumatic restorative treatment in U.S. dental schools: a survey of predoctoral pediatric dentistry program directors

The International Dental Federation and World Health Organization have promoted the use of Atraumatic Restorative Treatment (ART) in modern clinical settings worldwide. In the United States, the practice of ART is not believed to be widely used, which may be a result of little attention given to ART training in predoctoral pediatric dentistry curricula in U.S. dental schools. This study investigated the extent of clinical and didactic instruction on ART provided in U.S. dental schools by surveying the predoctoral pediatric dentistry programs in 2010. Of the fifty-seven directors asked to complete the survey, forty-four responded for a response rate of 77 percent. Of these forty-four programs, 66 percent reported providing clinical training on ART, though only 14 percent provide this training often or very often. The types of ART training provided often or very often included interim treatment (18 percent) and single-surface cavities (14 percent) in primary teeth. However, ART was said to be rarely taught as a definitive treatment in permanent teeth (2 percent). Attitude was a major predictor, for clinical training provided and using professional guidelines in treatment decisions were associated with a positive attitude towards ART. These predoctoral pediatric dentistry programs used ART mainly in primary, anterior, and single-surface cavities and as interim treatment. As ART increases access of children to dental care, the incorporation of the ART approach into the curricula of U.S. dental schools should be facilitated by professional organizations.

Current cariology education in dental schools in Spanish-speaking Latin American countries

This study sought to provide an overview of current cariology education in Spanish-speaking Latin American dental schools. Data collection was via an eighteen-item survey with questions about curriculum, methods of diagnosis and treatment, and instructors' perceptions about cariology teaching. The response rate was 62.1 percent (n=54), and distribution of participating schools by country was as follows: Bolivia (four), Chile (four), Colombia (twenty-four), Costa Rica (one), Cuba (one), Dominican Republic (two), El Salvador (two), Mexico (six), Panama (two), Peru (four), Puerto Rico (one), Uruguay (two), and Venezuela (one). Forty percent of the responding schools considered cariology the key axis of a course, with a cariology department in 16.7 percent. All schools reported teaching cariology, but with varying hours and at varying times in the curriculum, and 77.8 percent reported having preclinical practices. The majority reported teaching most main teaching topics, except for behavioral sciences, microbiology, saliva and systemic diseases, caries-risk factors, root caries, erosion, and early caries management strategies. The most frequently taught caries detection methods were visual-tactile (96.3 percent), radiographic (92.6 percent), and the International Caries Detection and Assessment System (ICDAS) (61.1 percent). Respondents said their schools' clinics make an operative treatment decision when radiolucency is in the inner half of enamel (42.3 percent) for radiographic criteria and when the lesion is visually non-cavitated (5.8 percent). All respondents reported that their schools teach preventive strategies, but only 43.4 percent said they tie it to risk assessment and 40.7 percent said they implement nonsurgical management regularly.

Critical appraisal-based learning in a dental college in India: a randomized control study

This study examined the effect of critical appraisal exercises on the quality of preclinical tooth preparation skills and the confidence level of undergraduate dental students at a dental college in India. Forty-two student volunteers were randomly divided into critical appraisal (CA; n=19) and control (C; n=23) groups. Both groups were given conventional lecture and video demonstration; the CA group was also given critical appraisal exercises. Four evaluators assessed the incisor, canine, premolar, and molar preparations made by all students. The mean overall scores (reported as mean±SD) assigned to the CA group by all evaluators were significantly higher (independent t-test, p<0.05) than the C group for incisor (CA: 6.19±1.47, C: 5.09±1.52), canine (CA: 5.64±1.36, C: 4.50±1.35), premolar (CA: 5.88±1.03, C: 4.88±1.18), and molar (CA: 5.98±1.16, C: 5.20±0.71) teeth. The CA group also demonstrated a significant increase in self-confidence over that of the C group (repeated measures general linear model F=8.554, p=0.006). In this study, the critical appraisal exercises significantly improved the preclinical incisor, canine, premolar, and molar tooth preparation skills and the confidence level of the undergraduate dental students.

Improving light-curing instruction in dental school

Delivering an inadequate amount of light to a light-cured resin will result in a resin that is inadequately cured. This study measured the radiant exposure that students delivered to a simulated restoration to determine if instruction with immediate feedback increased the amount of light they delivered. The amount of light (radiant exposure in J/cm(2)) delivered to a simulated restoration by sixty-three dental students using the same curing light for twenty seconds was recorded. The experiment was repeated after the students had been given detailed light-curing instructions together with immediate feedback using the MARCPS system. Initially, the students delivered between 1.4 and 17.5 J/cm(2) (mean±SD: 9.8±3.5 J/cm(2)). After receiving instructions and feedback on their light-curing technique, they delivered between 6.7 J/cm(2) and 17.8 J/cm(2) (mean±SD: 13.2±3.3 J/cm(2)). ANOVA and Fisher's post hoc multiple comparison tests showed that providing immediate feedback on the students' light-curing technique made a significant improvement in the radiant exposure they delivered (p<0.05). It was concluded that many dental students in this study were not using the curing light properly. After the students had received one session of additional instruction and immediate feedback using the MARC-PS, they delivered 35 percent more light energy to the same simulated restoration. Students who were closer to graduation showed a greater improvement in their light-curing technique (p=0.0091).

Framework for e-learning assessment in dental education: a global model for the future

The framework presented in this article demonstrates strategies for a global approach to e-curricula in dental education by considering a collection of outcome assessment tools. By combining the outcomes for overall assessment, a global model for a pilot project that applies e-assessment tools to virtual learning environments (VLE), including haptics, is presented. Assessment strategies from two projects, HapTEL (Haptics in Technology Enhanced Learning) and UDENTE (Universal Dental E-learning), act as case-user studies that have helped develop the proposed global framework. They incorporate additional assessment tools and include evaluations from questionnaires and stakeholders' focus groups. These measure each of the factors affecting the classical teaching/learning theory framework as defined by Entwistle in a standardized manner. A mathematical combinatorial approach is proposed to join these results together as a global assessment. With the use of haptic-based simulation learning, exercises for tooth preparation assessing enamel and dentine were compared to plastic teeth in manikins. Equivalence for student performance for haptic versus traditional preparation methods was established, thus establishing the validity of the haptic solution for performing these exercises. Further data collected from HapTEL are still being analyzed, and pilots are being conducted to validate the proposed test measures. Initial results have been encouraging, but clearly the need persists to develop additional e-assessment methods for new learning domains.

Use of a visible light-cured periodontal dressing material as a temporary restoration for inlay/onlay preparations

There are numerous materials that are used as temporaries for inlay and onlay preparations while the permanent restoration is being made. This article looks at 2 types of temporary materials that were placed into inlay or onlay preparations by student dentists: a methylmethacrylate acrylic material (DuraLay Inlay Pattern Resin) and a visible light-cured (VLC) periodontal surgical dressing (Barricaid). The resilience and effectiveness of both products are compared and evaluated for use as temporary restorations in inlay or onlay preparations. The study found that use of the VLC periodontal dressing material offers a novel technique for a quick and efficient method to provide a temporary restoration for various inlay and onlay preparations.

Current trends in community-based clinical teaching programs in U.K.and Ireland dental schools

Community-based clinical teaching/outreach programs using a variety of approaches have been established in many predoctoral dental schools around the world. The aim of this article is to report current trends in the teaching of community-based clinical teaching/outreach teaching in dental schools in the United Kingdom and Ireland. In late 2010-early 2011, a questionnaire was distributed by e-mail to deans of the eighteen established dental schools in the United Kingdom and Ireland. The questionnaire included both open and closed questions relating to current and anticipated trends in community-based clinical teaching. Fourteen responses were received (response rate=78 percent). All fourteen responding schools reported inclusion of a community-based clinical teaching program. Ten schools indicated that their program was based on total patient (comprehensive) care including the treatment of child patients. In nine schools, the program is directed by a senior clinical academic in restorative dentistry. As well as student dentists, ten schools and seven schools include teaching of student dental therapists and student dental hygienists, respectively. There is a varied experience within the schools surveyed in terms of the extent, nature, and content of these programs. Overall, however, community-based clinical teaching was seen as part of the future of dental school education in many schools as an ideal way of preparing graduates for Dental Foundation Training and subsequent independent practice.

Increasing dental student diversity through the UNLV Dental Prospects Program

Adequately providing for the health care of the growing minority population in the United States requires increased racial and ethnic diversity of the health care workforce. Long-term diversity in the dental profession depends on a more diverse student population in dental schools. The University of Nevada, Las Vegas School of Dental Medicine's (UNLV SDM) Dental Prospects Club is a predental education program that has increased the number of underrepresented minority and disadvantaged students in the school by concentrating on outreach, recruitment, and retention initiatives. The approaches used by the club members and faculty advisors to increase the number of underrepresented minority students recruited to and enrolled in the UNLV SDM are discussed in this report. Also described are the strategies, methods, internal infrastructure, and organizational support used to increase the number of underrepresented minority students at the school.

Predoctoral dental implant education at Creighton University School of Dentistry

The purpose of this report is to describe the dental implant education that predoctoral students receive and to characterize the patient population receiving implants at Creighton University School of Dentistry (CDS). CDS has no postdoctoral residency programs. Therefore, clinical management of diagnosis, treatment planning, surgical aspects, restoration, complications, and maintenance of dental implants requires significant involvement by predoctoral dental students. CDS implant education involves radiology diagnostic assets of the General Dentistry Department (including the use of Cone Beam Computed Tomography), as well as faculty and equipment from the Departments of Oral and Maxillofacial Surgery, Periodontics, and Prosthodontics, with a majority of students satisfied with their didactic preparation for their clinical experiences. Focusing on a three-year window from August 2007 to August 2010 and using electronic health records, this study found that a total of 242 implants were placed, out of which six failed within one year of placement and had to be removed. The average age of the population of 153 patients was found to be 53.3 years, with a range of eighteen to eighty-nine. Treatment outcomes compared very favorably with those published in the literature.